What is the indication for a liver biopsy in the hepatitis C virus (HCV)-positive patient waiting for renal transplantation?
Gianni Piredda, MD
The only gold standard method for knowing the actual stage of the disease due to HCV infection is liver biopsy. Therefore, when we do a liver biopsy it tells us how much inflammation and fibrosis there is. On the basis of that, we can grade and stage liver disease and predict the prognosis. For example, if a patient has stage 4 fibrosis (cirrhosis), he/she should be considered for combined liver/kidney transplantation for the best potential outcome. On the other hand, if a patient has mild disease, treatment with antiviral therapy in hopes of clearing the virus before kidney transplantation should be considered. This strategy should prevent precluding the patient from kidney transplantation and severe complications during the postoperative period due to underlying liver disease. In most academic centers, if a patient is on the kidney transplant waiting list and has HCV infection, a liver biopsy is done to stage the disease.