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Histological features of chronic hepatitis C in haemodialysis patients

Authors

  • Stratigoula Sakellariou,

    Corresponding author
    1. First Department of Pathology, Medical School, University of Athens, Athens, Greece
    • Correspondence

      Sakellariou Stratigoula, First Department of Pathology, Medical School, University of Athens, 75 Mikras Asias Str, Goudi, 11527, Athens, Greece

      Tel: +30 210 7462 174

      Fax: +30 210 7462 157

      e-mail: sakellarioustrat@yahoo.gr

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  • John N. Boletis ,

    1. Department of Nephrology and Renal Transplantation Unit, Medical School, University of Athens, Laiko General Hospital, Athens, Greece
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  • Vana Sypsa,

    1. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
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  • Mina Psichogiou,

    1. First Department of Internal Medicine, Propaedeutic, Medical School, University of Athens, Laiko General Hospital, Athens, Greece
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  • Dina Tiniakos,

    1. Laboratory of Histology and Embryology, Medical School, University of Athens, Athens, Greece
    2. Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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  • Ioanna Delladetsima

    1. First Department of Pathology, Medical School, University of Athens, Athens, Greece
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Abstract

Background & Aims

HCV infection in haemodialysis (HD) patients is still a matter of investigation. The aim of this study was to determine the histology of chronic hepatitis C (CHC) in HCV-infected HD patients within the context of a comparative analysis including non-uraemic patients with CHC. The relative importance of virological, demographic and clinical parameters on disease manifestation was examined.

Methods

Sixty-one consecutive liver biopsies from HD patients and 326 from non-uraemic patients with chronic HCV infection were comparatively evaluated.

Results

Haemodialysis patients with CHC were older than control subjects (P = 0.031), showing a similar HCV genotype distribution (P = 0.328) and lower viral load (P = 0.001). CHC in HD patients was significantly milder according to stage (P = 0.033), grade and its parameters (periportal activity, portal inflammation and lobular activity) (P < 0.001). The frequency of lymphoid aggregates (10.2% vs 50%, P < 0.001), bile duct lesions (1.7% vs 22.1%, P < 0.001) and extent of steatosis (P = 0.022) in HD group was significantly reduced. Multivariate analysis showed that non-uraemic patients had 2.3 times higher risk of developing steatosis independently of genotype distribution and age. In HD group, genotype 3, longer HD duration and age at infection were significantly associated with steatosis, while older age at infection correlated with advanced fibrosis.

Conclusions

Chronic hepatitis C in HD patients is usually very mild, losing its diagnostic histological features while patient's age and age at infection retain their prognostic significance. The weak inflammatory response, probably because of immunocompromised status and low viral load, may present a beneficial factor in the natural course of the disease.

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