Haemodialysis patients with hepatitis C: should they be considered for renal transplant

Objectives : To evaluate the relationship between transaminase (ALT/AST) levels and liver histology in patients with hepatitis C (HCV) antibodies and draw guidelines for assessing the suitability of haemodialysis patients with HCV for renal transplant (RT). Subjects : All patients were medically stable, with no recent viral illness and all had a history of previous blood transfusion. All had previously been infected with hepatitis A and cytomegalovirus (CMV), and nine had previously been infected with hepatitis B. None were known to be taking hepatotoxic medication and none had any stigmata of chronic liver disease. Setting : North West Armed Forces Hospital, Tabuk. Results : There was no correlation between the level of transaminase (ALT and AST) serum albumin, or the severity of the histopathological finding. Three had chronic active hepatitis (CAH) and two had chronic persistent hepatitis ; eight had chronic lobular hepatitis. Conclusion : It is difficult to predict the effect of long-term immunosuppressive treatment or the progression of HCV infection after RT. A patient with CAH or early cirrhosis should be excluded. Transaminase is no guide to the liver histology and liver biopsy is essential to rule out chronic liver disease prior to RT.