Liver biopsy in patients on hemodialysis with hepatitis C virus infection: An important tool

Hepatitis C virus (HCV) infection is commonest blood borne infection amongst hemodialysis patients. Still, there is paucity of data on liver biopsy in these patients. Our center is doing regular liver biopsy in these patients and thus thought of sharing our experience. In this retrospective study, all patients with HCV infection on hemodialysis were subjected to liver biopsy. Serum bilirubin, liver enzyme, HCV-PCR, genotype and viral load measurement were done in all. Biopsy specimen was stained with H and E, Periodic Acid Schiff, Gomori Stain, Masson Trichrome and Perls Stain. International Working Group scoring system of Ishak et al. was used for Grading and Staging. Of the 270 liver biopsies, mean age of patients was 34.05 ± 10.28 years and 233 (85.3%) were males. Mean duration of hemodialysis was 10.9 ± 7.4 months while of known HCV infection was 5.2 ± 4.0 months. Genotype 3 was commonest followed by 1. All had normal bilirubin and 64 (23.1%) had normal ALT. In 37 (13.3%) patients anti-HCV was not detectable. Mean histology grade was 4.03 ± 1.65 (1-10) and stage was 0.75 ± 0.98 (0-3). Only one patient had cirrhosis on histology. Associated hemosiderosis was seen 10 patients. Only minor complications were observed with no mortality. In conclusion, our study shows that in one-fourth patients with active liver disease, liver enzymes are persistently normal in patients on hemodialysis. Further, carefully performed liver biopsy is reasonably safe procedure though some patients do have non-fatal complications. Liver biopsy helps in assessing disease activity, which otherwise cannot be assessed. Histological grade and stage in these patients is usually mild and cirrhosis is rare. Till such time other non-invasive test is validated, liver biopsy will remain an important test in these patients.