The Present Role of Liver Biopsy in Kidney Transplant Candidates in the Management of Hepatitis B and C Patients

This chapter will deal with the present role of Liver Biopsy in determining liver disease prognosis in hepatitis B and C patients on haemodialysis and its role in establishing treatment strategies and in the decision-making process prior to kidney transplant. In recent years, progress has been made in determining the natural history of this disease in renal patients (Espinosa et al., 2004; Jadoul et al., 2004). Chronic hepatitis due to HCV is frequent in renal transplant recipients and in dialysis patients and has a significant impact on their survival (Hanafusa et al., 1998; Orloff et al., 1995; Pouteil-Noble et al., 1995). Mathurin et al., (1999) demonstrated in a case-control study that anti-HCV and HBsAg positive were independently associated with patient and graft survival. This was the first time that a 10 year follow-up was carried out; previous publications are based on shorter follow-ups and fewer patients. It is known that the prevalence of chronic infection with the hepatitis C virus (HCV) in patients with chronic kidney disease is higher than in the general population (Lavanchy, 2009). The estimated prevalence of chronic infection in haemodialysis patients is 13%, ranging from 10 to 65 %, depending on the geographical zone (Hmaied et al., 2006; Huraib et al., 1995; Santos & Souto, 2007; Shamshiraz et al., 2004). When considering patients candidates to kidney transplantation we have to take into account that immunosuppressive therapy after renal transplantation predisposes a reactivation of chronic viral hepatitis B or C, which is usually a mild disease for patients remaining under haemodialysis. It should be noted that HBV and HCV may induce de novo glomerulonephritis and chronic allograft nephropathy which can lead to graft failure (Aouifi & Garcia, 2001). In such cases, patients have to undergo dialysis again and therefore it is beneficial to eradicate HCV RNA before transplantation and to control and maintain HBV DNA negative (Huskey & Wiseman, 2011). A routine liver histological analysis could improve a patient’s chance of being selected for renal transplantation. Liver biopsy has been considered the “gold standard” for many years, because it provides us with information that was otherwise unobtainable (Ghany et al., 2010). Nowadays however, due to progress in non-invasive methods, liver biopsy is only