End-stage renal disease and hepatitis C infection: comparison of alanine aminotransferase levels and liver histology in patients with and without renal damage

Background and aim: To what extent the serum levels of alanine aminotransferase (ALT) are related to histological characteristics of liver damage caused by hepatitis C virus (HCV) infection among patients with end-stage renal disease (ESRD) remains unclear.Methods: Patients with a positive anti-HCV antibody titer confirmed by supplemental tests were evaluated by liver biopsy. We compared ALT levels in patients with and without renal damage, with similar histological grades and stages of inflammation and fibrosis. Patients were divided into two groups: patients with ESRD (n = 25) and patients without renal damage (n = 39).Results: The ALT level was 42.1 ± 24.3 IU/L for the ESRD group, compared with 109.9 ± 55.8 IU/L for the non-ESRD group (P < 0.001). Liver inflammation (modified Knodell grade) was 4.0 ± 2.1 in the ESRD group versus 5.2 ± 2.4 in the non-ESRD group; fibrosis (6-point scale) was 1.1 ± 1.2 versus 1.7 ± 1.5, respectively.Conclusions: Despite histological evidence of liver inflammation, ALT levels in the ESRD group were normal, while ALT levels were significantly higher in the non-ESRD group with similar levels of liver inflammation. In conclusion, ALT levels are not a useful indicator of HCV infection in patients with ESRD and liver biopsies should be recommended for kidney transplant candidates.