Liver Disease Patterns in Hemodialysis Patients With Antibodies to Hepatitis C Virus

Caramelo, Carlos; Ortíz, Alberto; Aguilera, Beatriz; Porres, Juan Carlos; Navas, Sonia; Marriott, Eduardo; Alberola, M.; Alamo, Concepción; Galera, Ana; Garreño, M.P.; González‐Parra, Emilio; Gabriel, M.; Oliva, H; Carreflo, V.

doi:10.1016/s0272-6386(12)70341-4

Cited by 86 publications

(36 citation statements)

References 23 publications

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“…Pretransplant liver biopsies from 207 patients showed that, although the majority of patients had no fibrosis, approximately 10% had stage 3/4 disease. This is in concordance with other published studies [33][34][35][36][37] and emphasizes the importance of the pretransplant liver biopsy in identifying well-compensated ESRD patients with advanced liver disease. As recommended by the Kidney Disease: Improving Global Outcomes workgroup, 16 patients with advanced liver disease should be cautiously considered for kidneyalone transplant and perhaps referred for combined liverkidney transplantation.…”

Section: Discussionsupporting

confidence: 92%

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Roth¹,

Gaynor

Reddy³

et al. 2011

Journal of the American Society of Nephrology

129

128

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The long-term outcome of kidney transplantation in patients infected with hepatitis C virus (HCV) and end stage renal disease (ESRD) is not well described. We retrospectively identified 230 HCV-infected patients using enzyme immunoassay and nucleic acid testing obtained during the transplant evaluation. Of 207 patients who had a liver biopsy before transplant, 44 underwent 51 follow-up liver biopsies at approximately 5-year intervals either while on the waitlist for a kidney or after kidney transplantation. Advanced fibrosis was present in 10% of patients biopsied, identifying a population that may warrant consideration for combined liver-kidney transplantation. Kidney transplantation does not seem to accelerate liver injury; 77% of kidney recipients who underwent follow-up biopsies showed stable or improved liver histology. There was a higher risk for death during the first 6 months after transplant, but undergoing transplantation conferred a long-term survival advantage over remaining on the waitlist, which was evident by 6 months after transplant (HR, 0.32; 95% CI, 0.17 to 0.62). Furthermore, the risk for death resulting from infection was significantly higher during the first 6 months after transplant (HR, 26.6; 95% CI, 5.01 to 141.3), whereas there was an early (Յ6 months) and sustained decrease in the risk for cardiovascular death (HR, 0.20; 95% CI, 0.08 to 0.47). In summary, these data suggest the importance of liver biopsy before transplant and show that kidney transplantation confers a long-term survival benefit among HCV-infected patients with ESRD compared with remaining on the waitlist. Nevertheless, the higher incidence of early infection-related deaths after transplant calls for further study to determine the optimal immunosuppressive protocol.

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Section: Discussionsupporting

confidence: 92%

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Roth¹,

Gaynor

Reddy³

et al. 2011

Journal of the American Society of Nephrology

129

128

View full text Add to dashboard Cite

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“…patients are frequently anti-HCV positive and have a high Saunders, 1992:253-282. incidence of hemosiderosis. 24 Therefore, even in pediatric and HBV were excluded, and some of these patients had This tendency was also observed in our pediatric patients, prospective study of posttransfusion hepatitis among thalassemic chiland there was a correlation between the stage and grade.…”

Section: Methodssupporting

confidence: 66%

Pathology of chronic hepatitis C in children

et al. 1997

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Extensive studies on hepatitis C have been conducted since Limited information is available regarding the histology of the specific serological test for hepatitis C virus (HCV) infechepatitis C virus infection in children. The aim of this study tion was developed, and the characteristics of this disease was to determine the histological pattern of chronic hepatitis have been established. [1][2][3][4] Recent pathological studies have C (CHC) in children, and liver biopsy specimens from 109 clearly defined the histological characteristics of chronic heppediatric patients with CHC were examined. Each biopsy atitis C (CHC), e.g., lymphoid aggregates in the portal tract, specimen was evaluated based on a numerical scoring system bile duct damage, and large-droplet fatty changes, in comparfor the stage of fibrosis (1-4), the grade of portal/periportal ison to chronic hepatitis B (CHB). [5][6][7] However, in-depth studnecroinflammation (0-4), the grade of lobular necroinflammaies of CHC in children have not been conducted, and the tion (0-4), and their sum (final grade). The histological lesions histological characteristics of this disease in pediatric patients considered to be characteristic of chronic hepatitis were also remained to be identified, although it is well known that evaluated. None of the children had liver cirrhosis, and 105 even pediatric patients with CHB have various degrees of cases (97%) were stage 1 or 2. Only 4 children were stage 3.hepatic lesions ranging from mild fibrosis to liver cirrhosis. 8 Two of these 4 cases showed hemosiderosis. A significant Some studies have reported histopathology of CHC in pediatcorrelation was observed between the staging score and the ric patients, 9-13 but they examined only a small number of final grade in the pediatric patients (r Å .59; P õ .0001). The liver biopsy specimens, and their histological evaluation histological characteristics of adult CHC, such as lymphoid methods differed. For example, Inui et al. 9 examined the aggregate, bile duct injury, and fatty changes, were also obliver biopsy specimens of 25 pediatric patients with CHC served in the children. In conclusion, the majority of children who were all transfusion associated, but the investigators did with CHC presented with mild fibrosis, but a few showed not find liver cirrhosis. In contrast, Lai et al. 10 followed up CHC with lobular distortion and hemosiderosis. Frequent 46 thalassemic children who were treated with blood transfublood transfusion may aggravate hepatic lesions in pediatric sions and found that 5 patients (11%) developed liver cirrho-CHC. (HEPATOLOGY 1997;26:771-775.) sis during the following 8 years.The present study was designed to clarify the histological changes in the liver of pediatric patients with CHC. PATIENTS AND METHODSAbbreviations: HCV, hepatitis C virus; CHC, chronic hepatitis C; CHB, chronic hepatitis B.Patients. We collected 109 biopsy specimens from 109 pediatric men and 62 women who ranged in age from 23 to 95 years old Received September 27, 1996; accept...

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“…The majority of HDpatients with HCVhave only a minimal derangement in the ALTlevel (1,6). However, recent histological analysis of the liver tissue indicates that HDpatients with HCVoften have chronic active hepatitis or cirrhosis (7,8). The serum level of vitamin B6 which is indispensable for the measurement ofALTactivity is reduced in HDpatients (14).…”

Section: Discussionmentioning

confidence: 99%

“…Uremia is considered to predispose a patient to a chronic viral carrier status with little inflammatory activity in the liver. However, recent studies analyzing the liver biopsy samples of HD patients with HCVhave shownthat a large proportion of the patients have apparent chronic liver disease such as chronic active hepatitis and cirrhosis (7,8). Moreover, changes in immunestatus caused by immunosuppression after renal transplantation can promote the development of clinically significant inflammatory liver disease.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Characterization of Hepatitis C Virus in Hemodialysis Patients.

et al. 1999

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Object Chronic hepatitis C virus (HCV) infection is commonin hemodialysis (HD) patients. In the present study, the prevalence and properties of HCVin HDpatients were analyzed. Methods and Results Of 125 HDpatients, 34 (27%) were positive for antibody to HCV,and HCV-RNA was detected in 23 (68%) of the 34 patients using reverse transcription polymerase chain reaction. The HCV-RNA sequence analysis did not identify the alterations specific to HDpatients with HCV,although one patient had a variant virus containing the deletion of the core gene sequence. Whenserial changes in the levels of HCV-RNA were evaluated in 15 patients by a branched DNAassay, the values decreased immediately after HDprocedure, but returned to the baseline values 2 days after the procedure. Conclusion These results indicate that HCVin HDpatients is replication-competent, although a transient reduction in the levels of HCV-RNA occurs during HD. (Internal Medicine 38: 626-631, 1999)

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Liver Disease Patterns in Hemodialysis Patients With Antibodies to Hepatitis C Virus

Cited by 86 publications

References 23 publications

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Effect of Kidney Transplantation on Outcomes among Patients with Hepatitis C

Pathology of chronic hepatitis C in children

Prevalence and Characterization of Hepatitis C Virus in Hemodialysis Patients.

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