Comparison of clinical features and liver histology in hepatitis C-positive dialysis patients and renal transplant recipients

Objective: Liver biopsies in hepatitis C virus (HCV)positive end stage rena l disease (ESRD) patients before or after renal transplantation were compar ed to study the effect of transplant-related immunosuppression, Methods: In this prospective study all patients on the active transplant list and all patients with functioning renal transplants at our hospital were tested for HCV antibody (ELISA-2) over a 30-month period. HCV infection was confirmed by polymerase chain reaction in most patients. All HCV-positive patients w ere asked to undergo liver biopsy without regard to serum transaminase leve ls. Patients mere interviewed, examined, and had detailed chart review, By protocol, liver histology was evaluated according to stage and inflammatory activity in a blinded fashion. Results: There were 129 HCV-antibody-positi ve patients, of 795 tested. Sixty-seven agreed to liver biopsy. Of these, 2 2 patients had never been transplanted and 45 had received transplants. Mea n transplant duration before biopsy was 41.2 months (range, 1-204 months), Transplant patients had significantly longer duration of ESRD and estimated duration of HCV infection than patients not transplanted, Dialysis patient s had significantly more portal inflammatory activity and lymphoid follicle s on biopsy whereas transplant patients had more piecemeal necrosis and ste atosis, However, the total histological activity score and stage were simil ar between groups. Multivariate analysis confirmed the association between transplant and steatosis, But independent variables including transplant du ration, HCV infection duration, and ESRD duration were not correlated with histological findings. Conclusion: Renal transplantation may not be associa ted with an increased risk of progressive liver disease in HCV-positive pat ients, compared with ESRD patients receiving chronic dialysis. Long-term st udies with serial liver biopsies are needed to resolve this issue. (C) 1999 by Am. Cell. of Gastroenterology.