LIVER-DISEASE IN DIALYSIS PATIENTS WITH ANTIBODIES TO HEPATITIS-C VIRUS

Eighty-three patients with chronic end-stage renal failure, including 65 on haemodialysis and Is on intermittent peritoneal dialysis, were e valuated for hepatitis B virus profile and antibodies to hepatitis C v irus (HCV). All those positive for HBsAg were excluded from the study. Nineteen patients were found to be positive for antibodies to HCV by the ELISA II test. Eight cases were already positive for HCV antibody when they started dialysis in our unit, the other 11 became positive d uring dialysis in our unit. Only one of the patients on peritoneal dia lysis was positive for HCV. A liver biopsy was obtained from 17 patien ts, who consented to the procedure. All the cases were evaluated for t he number of blood transfusions received, HIV infection and the approx imate time of contracting the HCV infection. Liver enzymes were determ ined every month. Only three patients had abnormally raised serum amin otransferase at the time of biopsy. The various histopathological lesi ons detected were chronic active hepatitis (n = 3, including one with changes consistent with cirrhosis), chronic persistent hepatitis (n = 4), non-specific hepatitis (n = 3) and haemosiderosis (n = 3); four bi opsy samples were normal. There was no correlation between the biochem ical and histopathological changes. Moreover, patients with normal ser um aminotransferase levels had abnormal histopathological changes. Al were negative for HIV and none of the patients had received a renal gr aft. Twelve patients had received blood transfusions varying from 2 to 12 units, four had not received any blood, and in one the history of blood transfusion could not be confirmed. The four patients with anti- HCV antibodies who had not received blood transfusion had relatively m ild disease -non-specific hepatitis (n = 2) or normal biopsy (n = 2). One patient with cirrhosis died 30 months after liver biopsy from hepa tic insufficiency and three received renal transplants. Others are con tinuing on dialysis and their biochemical tests are within normal limi ts 12-45 (30 +/- 14) months after biopsy. In conclusion, biochemical t ests are poor indicators of liver disease, and liver biopsy is a defin itive way of evaluating the patients of dialysis with positive HCV ant ibodies for prognosis.