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Characteristics of hepatitis C in renal transplant candidates
Scott J Cotler1, Gloria Diaz, Sushama Gundlapalli
1Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, U.S.A. scotler@rush.edu
Insights
Patients with end-stage renal disease (ESRD) had less severe hepatitis C liver disease than control subjects. Clinical factors did not predict disease severity in ESRD patients, and transjugular liver biopsy is recommended for staging.
Area of Science:
- Hepatology
- Nephrology
- Transplantation
Background:
- Hepatitis C is prevalent in dialysis patients and poses risks for renal transplant recipients.
- Advanced hepatitis C often leads to exclusion from renal transplantation.
Purpose of the Study:
- To characterize hepatitis C in patients awaiting renal transplantation.
- To compare hepatitis C-related liver disease in end-stage renal disease (ESRD) patients versus matched controls without renal disease.
Main Methods:
- Compared demographic, laboratory, and histologic data of 46 renal transplant candidates with ESRD against 46 matched controls.
- Analyzed liver disease severity, inflammation, and fibrosis between the two groups.
Main Results:
- ESRD patients exhibited significantly lower alanine aminotransferase levels and less inflammatory activity.
- A lower proportion of ESRD patients had bridging fibrosis or cirrhosis (13%) compared to controls (30%).
- Hepatitis C virus RNA levels were similar; clinical features did not predict histologic findings in ESRD patients.
Conclusions:
- Patients with ESRD showed less severe hepatitis C liver disease than controls.
- Transjugular liver biopsy is advised for staging hepatitis C in renal transplant candidates due to percutaneous biopsy risks in uremic patients.
Goals:
To characterize hepatitis C in renal transplant candidates and to compare hepatitis C-related liver disease between patients with end-stage renal disease (ESRD) and well-matched control subjects without renal disease.
Background:
Hepatitis C is common in dialysis patients and can cause morbidity and mortality in renal transplant recipients. Patients with advanced hepatitis C often are excluded from renal transplantation.
Study:
Forty-six renal transplant candidates and 46 control subjects matched for age, sex, and race without renal disease were included. Demographic, laboratory, and histologic data were compared between patients with ESRD and control subjects.
Results:
Alanine aminotransferase levels were significantly lower in patients with ESRD (p < 0.001). Hepatitis C virus RNA levels were similar between groups. Patients with ESRD had less inflammatory activity (p < 0.001) and a lower proportion of bridging fibrosis or cirrhosis (13%) than control subjects (30%, p = 0.043). Clinical and laboratory features did not predict histologic grade or stage of hepatitis C in patients with ESRD. Two complications of percutaneous liver biopsy occurred per three diagnoses of cirrhosis in patients with ESRD. No complications occurred with transjugular liver biopsy in this group.
Conclusions:
Patients with ESRD had less severe hepatitis C than did control subjects. Clinical measurements did not predict histologic findings in renal transplant candidates. Transjugular liver biopsy should be considered to stage hepatitis C in renal transplant candidates due to the risk of percutaneous biopsy in uremic patients.