Characteristics of hepatitis C in renal transplant candidates.

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.