Histopathological heterogeneity in fulminant hepatic failure

Abstract

The clinicopathological features of 38 patients admitted consecutively for fulminant hepatic failure were studied. Histopathological material was reviewed in all patients. Both percutaneous and whole livers (either explanted or autopsy specimens) were available in 16 patients: whole livers only in 12 patients and biopsy specimens only in 10 patients. All patients were negative for antibodies to hepatitis C, whereas 24% had hepatitis B infection and 10% had adverse drug reactions. Livers from 75% of patients showed confluent hepatic necrosis. However, there was considerable variability in the extent of necrosis, and biopsy specimens from about 50% of the most severely affected livers showed only minimal bridging necrosis. In patients with massive hepatic necrosis, percutaneous liver biopsy specimens were frequently misleading because of regional inhomogeneities. Interestingly, five patients (13%) had established cirrhosis at the time of diagnosis. The best clinical predictors of survival were age and the maximal grade of encephalopathy. By contrast, neither the severity of confluent hepatic necrosis nor the etiology predicted the decision to transplant or the outcome. There were no differences in the histopathology corresponding to different etiologies. In summary, the approach to the patient with fulminant hepatic failure should be guided principally on clinical grounds, and further classification should be based on pathological and etiologic considerations. However, histological classification and prognosis based on percutaneous biopsy specimens alone may be misleading.

Acute liver failure: Clinical features, outcome analysis, and applicability of prognostic criteria

“…In such patients, other factors, such as a liver biopsy and plasma group-specific component protein level, may be helpful. 17,[28][29][30][31] Thus, ALF is a clinical syndrome associated with high morbidity and mortality. Although its management has been revolutionized by the availability of OLT, the impact of OLT has been dampened by the shortage of donor organs.…”

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“…Pathophysiology of acute liver failure include extensive loss of hepatocytes or massive necrosis as a result of inflammatory mediators and cytokines such as TNF-α and IL-1infiltration and up regulation of ICAM-1 mRNA in the liver during endotoxemia [23,24]. There are no differences in the histopathology corresponding to different etiologies and histologic classification and prognosis based on biopsy specimens alone may be misleading [13].…”

“…On the other hand liver histologic evaluation in acute liver failure is associated with substantial sampling error and potential complications and does not reliably predict outcome so percutaneous or transjugular liver biopsy is not recommended [13]. A variety of therapies have been proposed and studied in patients with acute liver failure but only liver transplantation, has permitted salvage of patients with irreversible liver failure [14].…”

Acute liver failure associated with prolonged use of bromfenac leading to liver transplantation

“…A similar heterogeneity of histological findings in patients presenting with acute liver failure caused by drugs and other causes has been noted. 15 Severe NSAID hepatotoxicity leading to hospitalization or death is rare. However, because of their enormous worldwide consumption, NSAIDs have become an important class of drugs responsible for drug-induced liver injury.…”