Histopathological impacts of hepatitis virus infection in hemodialysis patients: should liver biopsy be performed before renal transplantation?

To evaluate the histologic changes in the livers of renal transplant candidates who were infected with hepatitis viruses, we performed a percutaneous liver biopsy in each of 74 regular hemodialysis patients. Forty percent of them were seropositive for the antibody to hepatitis C virus (anti-HCV) whereas 29.7% had anti-HCV and antibody to hepatitis B surface antigen (anti-HBs) concomitantly. Seven (9.5%) were seropositive for only hepatitis B surface antigen HBsAg. Histopathological examination revealed that 30% of patients had chronic active hepatitis (CAH), 11% had chronic persistent hepatitis (CPH), and 3% displayed histopathological evidence of cirrhosis. Eleven of 22 patients with CAH were positive for only anti-HCV, and 2 of 22 were positive for only HBsAg. One patient had HBsAg and anti-HCV together, and 8 of 22 had anti-HBs and anti-HCV concomitantly. None of the anti-HBs positive patients exhibited abnormal histopathological changes. We found no statistically significant difference in histopathological findings between the HBsAg positive and anti-HCV positive patients. As 32 of 74 patients (43%) had some degree of chronic liver disease, we concluded that it is prudent to evaluate liver histology in HBsAg and anti-HCV seropositive renal transplant candidates before transplantation.