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Liver disease in adult transfusion‐dependent beta‐thalassaemic patients: investigating the role of iron overload and chronic HCV infection
Author(s) -
Kountouras Dimitrios,
Tsagarakis Nikolaos J.,
Fatourou Evangelia,
Dalagiorgos Efthimios,
Chrysanthos Nikolaos,
Berdoussi Helen,
Vgontza Niki,
Karagiorga Markissia,
Lagiandreou Athanasios,
Kaligeros Konstantinos,
Voskaridou Ersi,
Roussou Paraskevi,
DiamantiKandarakis Evanthia,
Koskinas John
Publication year - 2013
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12095
Subject(s) - medicine , liver biopsy , hepatitis c virus , gastroenterology , fibrosis , liver disease , ferritin , hepatitis c , cohort , immunology , biopsy , virus
Abstract Background Iron overload and hepatitis‐ C virus ( HCV ) infection, have been implicated in the evolution of liver disease, in patients with transfusion‐dependent beta‐thalassaemia major ( BTM ). However, the impact of these factors in late stages of liver disease in adults with BTM , has not been extensively studied. Aims To investigate serum indices of iron overload, HCV infection and liver disease, in a cohort of 211 adult G reek patients with BTM , in relation with the findings from liver biopsies. Methods In this cross‐sectional study, 211 patients with BTM were enrolled and studied, in relation with HCV infection, ferritin, transaminases, chelation treatment and antiviral treatment. Based on 109 patients biopsied, we correlated liver fibrosis, haemosiderosis and inflammation, with serum indices and HCV status Results Among all patients, 74.4% were anti‐ HCV positive ( HCV +). Ferritin was positively correlated with transaminases and negatively correlated with age, while it was not significantly different among HC V+ and HCV − patients. Among the HCV + patients, 55.4% reported antiviral treatment, while genotype 1 predominated. In a subfraction of 109 patients, in which liver biopsy was performed, 89% were HCV + and 11% HCV −. Fibrosis was significantly correlated with age ( P = 0.046), AST ( P = 0.004), ALT ( P = 0.044) and inflammation ( P < 0.001). Advanced fibrosis was present with even minimal haemosiderosis, independently of ferritin values or HCV history. Conclusions These data suggest that in the late stages of liver disease in BTM patients, iron overload may be the critical determinant, since fibrosis is related to the minimal haemosiderosis, independently of HCV history.