Transjugular Liver Biopsy in Patients with EndStage Renal Disease

Ahmad, Adel; Hasan, Fuad; Abdeen, Suad; Sheikh, Maharaj; Kodaj, Jan; Nampoory, M.R.N.; Johny, K.V.; Asker, Haifa; Siddique, Iqbal; Thalib, Luqman; Al‐Nakib, Basil

doi:10.1097/01.rvi.0000109403.52762.c4

Cited by 32 publications

(17 citation statements)

References 10 publications

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“…The authors found that both techniques obtained adequate specimens for histological diagnosis in all patients; however, the complications differed. There were no major complications in the transjugular liver biopsy group, whereas 12% of the patients in the percutaneous liver biopsy developed bleeding complications [36] . Some authors have reported the progression of HCV-related liver disease in HD patients who are on transplantation waiting lists.…”

Section: Diagnosis Of Hcv Infection In Patients With Esrdmentioning

confidence: 79%

“…Note that even when an experienced physician performs the biopsy and an experienced pathologist interprets the findings, this gold-standard technique is associated with up to 20% error in staging liver disease [34,35] . Ahmad et al [36] compared the results for 46 HD patients with chronic liver disease who underwent transjugular liver biopsy and 32 HD patients who had undergone percutaneous liver biopsy at the same institution. The authors found that both techniques obtained adequate specimens for histological diagnosis in all patients; however, the complications differed.…”

Section: Diagnosis Of Hcv Infection In Patients With Esrdmentioning

confidence: 99%

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Hepatitis C infection in hemodialysis patients: A review

Etık

Öcal

Boyacioglu

2015

WJH

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Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications posttransplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT.

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Section: Diagnosis Of Hcv Infection In Patients With Esrdmentioning

confidence: 79%

Section: Diagnosis Of Hcv Infection In Patients With Esrdmentioning

confidence: 99%

Hepatitis C infection in hemodialysis patients: A review

Etık

Öcal

Boyacioglu

2015

WJH

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“…12 Transjugular liver biopsy is an alternate route for obtaining liver specimens in patients with coagulation defects 13,14 and has been evaluated in the ESRD population. 15,16 Although safe, this procedure is not widely available and provides smaller samples than the intercostal technique, which might underestimate fibrosis staging. Hence, there is a need to develop accurate noninvasive tests to predict liver fibrosis, especially among dialysis patients with HCV infection in whom a higher risk for liver biopsy complications has been observed.…”

mentioning

confidence: 99%

Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection†

et al. 2007

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HCV infection is common among patients with end-stage renal disease (ESRD) on hemodialysis, and it has been considered an independent risk factor for mortality in this setting. Although liver biopsy in ESRD patients with HCV infection is useful before kidney transplantation, it carries a high risk of complications. We sought to assess the diagnostic value of noninvasive markers to stage liver fibrosis in 203 ESRD HCV-infected patients. Univariate and multivariate analysis were used to identify variables associated with significant fibrosis (METAVIR F2, F3, or F4 stages). Significant liver fibrosis was observed in 48 patients (24%). Logistic regression analysis identified AST and platelet count as independent predictors of significant fibrosis (P < 0.001 and P ‫؍‬ 0.001, respectively). The area under the receiver operating characteristic curve of the AST to platelet ratio index (APRI) for predicting significant fibrosis was 0.

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“…Once transplanted this risk disappears with the restoration of normal renal function. In some centres the transyugular route is the preferred one since is associated with less a reduced risk of bleeding and pain, and may allow measuring the hepatic venous pressure gradient (HVPG) for confirming and grading portal hypertension [12,13] .…”

Section: Pre-transplant Evaluationmentioning

confidence: 99%

Antiviral treatment for chronic hepatitis B in renal transplant patients

Ridruejo

2014

WJH

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Chronic hepatitis B infection is frequent in renal transplant patients. It negatively impacts long term outcomes reducing graft and patient survival. Current guidelines clearly define who needs treatment, when to start, what is the first line therapy, how to monitor treatment response, when to stop, and how patients must be controlled for its safety. There is some data showing a favorable safety and efficacy profile of nucleos(t)ide analogue (NUC) treatment in the renal transplant setting. Entecavir, a drug without major signs of nephrotoxicity, appears to be the first option for NUC naïve patients and tenofovir remains the preferred choice for patients with previous resistance to lamivudine or any other NUC. Renal transplant recipients under antiHBV therapy should be monitored for its efficacy against HBV but also for its safety with a close renal monitoring. Studies including a large number of patients with long term treatment and follow up are still needed to better demonstrate the safety and efficacy of newer NUCs in this population. Core tip: Nucleos(t)ide analogue treatment is safe and effective in renal transplant patients. It improves long term patients and graft survival.Ridruejo E. Antiviral treatment for chronic hepatitis B in renal transplant patients.

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Transjugular Liver Biopsy in Patients with EndStage Renal Disease

Cited by 32 publications

References 10 publications

Hepatitis C infection in hemodialysis patients: A review

Hepatitis C infection in hemodialysis patients: A review

Simple blood tests as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection†

Antiviral treatment for chronic hepatitis B in renal transplant patients

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