Is there a difference in liver histology between hepatitis c acquired through intravenous drug use (IVDU) Vs blood transfusion?

Abstract

It has been suggested by others that transfusion acquired hepatitis C is associated with more aggressive histological damage to the liver compared to hepatitis acquired from IVDU. We undertook this study to systematically investigate the pathologic difference(s) in liver histology, if any, between IVDU and transfusion related hepatitis C in our tertiary care institution using the modified histological scoring system of Knodell etal. We identified all patients with hepatitis C due to IVDU or transfusion from 1993 to November 1997 who underwent liver biopsy at our institution. The histology slides of these patients were reviewed by one blinded pathologist. Patients were excluded if they had less than 4 portal tracts on the liver biopsy specimen (32 patients). The clinical records of these patients were then reviewed. Patients were also excluded if they had another potential cause for liver damage (11 patients). Fifty-two (72%) patients had IVDU related hepatitis C and 19 (28%) transfusion-related in the final analysis. The 2 groups were demographically similar. Specifically, there were no statistical differences in age of the patients at the time of biopsy (44 years for the transfusion group and 40 years for the IVDU group) or the duration of disease (18.9 years vs 19.8 years, respectively). The Wilcoxon Rank Sum Test was used to compare the degree of fibrosis and the total histology score as well as the individual components of the histology score (portal inflammation, lobular necrosis and piecemeal necrosis) in the two groups. There was no statistical difference between the two groups in any of the variables. We then excluded patients with heavy alcohol intake (1 in the transfusion group and 18 in the IVDU group) to eliminate this as a potential confounder. Again, we not find any statistical difference in the same variables between the groups. We conclude, that at least in our population, there is no significant pathological difference between transfusion and IVDU related hepatitis C over a mean of 19 years.