Serial measurements of serum transaminases in renal transplant recipients with chronic hepatitis C: do they reflect disease severity?

Chronic hepatitis C infection is a common problem in renal allograft recipi ents. This study was designed to investigate the association of serum amino transferase levels with liver histology, in renal transplant patients with chronic hepatitis C virus (HCV) infection, in the long term. Methods. In this study, 82 HCV-infected renal allograft recipients, who wer e followed up with functioning grafts for at least 6 months, were analyzed. Patients were classified according to their transaminase values as persist ently normal, intermittently abnormal, or continuously abnormal liver funct ion tests. Serum transaminase levels exceeding at least 1.5 times the upper limit of normal (40 IU) for periods longer than month were taken as abnorm al. Patients with abnormal liver function tests owing to I-ICV unrelated ca uses (drugs, alcohol, or other toxic substances, other viruses, etc.) were excluded from the study. Forty-eight of these patients underwent at least o ne liver biopsy. Results. Of the 82 patients, 34 (41.5%) had persistently normal (liver biop sy revealed normal or minimal changes in 77.0%, chronic persistent hepatiti s in 15.3%, chronic active hepatitis in 7.7%; no patient had cirrhosis), 29 (35.3%) intermittently abnormal (liver histology was consistent with minim al changes in 50%, chronic persistent hepatitis in 27.8%, chronic active he patitis in 16.7%, cirrhosis in 5.5%), 19 (23.2%) persistently abnormal (liv er biopsy showed minimal changes in 41.1%, chronic persistent hepatitis in 17.6%, chronic active hepatitis in 35.3%, cirrhosis in 5.9%) transaminase v alues. Conclusion. Although continuously or intermittently elevated transaminases do not always indicate morphologically advanced disease, the normal course of serum transaminases is mostly accompanied by normal, or near-normal, liv er histology, in HCV-infected renal transplant patients. Liver biopsy is no t indicated in deciding disease severity in these: patients unless clinical findings dictate otherwise.