Liver disease in dialysis patients with antibodies to hepatitis C virus

Eighty-three patients with chronic end-stage renal failure,including 65 on haemodialysis and 18 on intermittent peritonealdialysis, were evaluated for hepatitis B virus profile and antibodiesto hepatitis C virus (HCV). All those positive for HBsAg wereexcluded from the study. Nineteen patients were found to bepositive for antibodies to HCV by the ELISA II test. Eight caseswere already positive for HCV antibody when they started dialysisin our unit, the other 11 became positive during dialysis inour unit. Only one of the patients on peritoneal dialysis waspositive for HCV. A liver biopsy was obtained from 17 patients,who consented to the procedure. All the cases were evaluatedfor the number of blood transfusions received, HIV infectionand the approximate time of contracting the HCV infection. Liverenzymes were determined every month. Only three patients hadabnormally raised serum aminotransferase at the time of biopsy.The various histopathological lesions detected were chronicactive hepatitis (n=3, including one with changes consistentwith cirrhosis), chronic persistent hepatitis (n = 4), non-specifichepatitis (n = 3) and haemosiderosis (n=3); four biopsy sampleswere normal. There was no correlation between the biochemicaland histopathological changes. Moreover, patients with normalserum aminotransferase levels had abnormal histopathologicalchanges. All were negative for HIV and none of the patientshad received a renal graft. Twelve patients had received bloodtransfusions varying from 2 to 12 units, four had not receivedany blood, and in one the history of blood transfusion couldnot be confirmed. The four patients with anti-HCV antibodieswho had not received blood transfusion had relatively mild disease-non-specifichepatitis (n=2) or normal biopsy (n=2). One patient with cirrhosis died 30 months after liver biopsyfrom hepatic insufficiency and three received renal transplants.Others are continuing on dialysis and their biochemical testsare within normal limits 12–45 (30± 14) monthsafter biopsy. In conclusion, biochemical tests are poor indicators of liverdisease, and liver biopsy is a definitive way of evaluatingthe patients of dialysis with positive HCV antibodies for prognosis.