Chronic hepatitis C infection in patients with end stage renal disease: Characterization of liver histology and viral load in patients awaiting renaltransplantation

OBJECTIVES: Hepatitis C virus (HCV) is common in patients with end stage re nal disease (ESRD) awaiting renal transplantation (RT). However, few data a re available on the liver histology and viral titer in these patients relat ive to patients with HCV and normal renal function. The aims of this study were to assess liver histology, quantitative HCV-RNA titer, and alanine ami notransferase (ALT) levels in patients with ESRD awaiting RT, and to identi fy clinical predictors of histological progression to advanced bridging fib rosis and/or cirrhosis. METHODS: A total of 50 consecutive patients (mean age 42 yr, 62% male) with ESRD and HCV, who were awaiting RT, underwent liver biopsy. Two HCV popula tions, one with persistently normal ALT and another with elevated ALT, both with normal renal function, served as controls. HCV-RNA titer was assessed by quantitative PCR. RESULTS: Of the patients with ESRD, 94% had normal ALT. Log HCV RNA filer w as significantly higher in patients with ESRD (5.8 +/- 0.3) than in either normal ALT (5.4 +/- 0.1) or elevated ALT (5.3 +/- 0.1) controls (p < 0.05). Knodell Histological Activity Index (HAI) In patients with ESRD was simila r to that observed in control patients with normal ALT (4.8 +/- 0.4 vs 4.9 +/- 0.4) but significantly less (P < 0.05) than that observed in control pa tients with elevated ALT (8.4 +/- 0.5). The percentage of patients with bri dging fibrosis or cirrhosis was similar in patients with ESRD and controls with persistently normal ALT (22% vs 13%) but significantly less (p < 0.001 ) than that observed in control patients with elevated ALT (48%). No signif icant differences in ALT, HCV-RNA titer, duration on hemodialysis, or time from first possible exposure was observed between ESRD patients with advanc e fibrosis (n = 11) and those with mild disease (n = 39). CONCLUSIONS: Our data suggest that liver biopsy is necessary to exclude sig nificant liver pathology in patients with HCV and ESRD, and to help define those patients in whom interferon treatment might be helpful. (Am J Gastroe nterol 1999;94:3576-3582. (C) 1999 by Am. Coll. of Gastroenterology).