Substantial hepatic necrosis is prognostic in fulminant liver failure

Paul Ndekwe, Marwan Ghabril, Yong Zang, Steven A. Mann, Oscar Cummings, Jingmei Lin

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Abstract

AIM to evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival. METHODS Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived. RESULTS The core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplantfree survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively). CONCLUSION Adequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.

Original languageEnglish (US)
Pages (from-to)4303-4310
Number of pages8
JournalWorld Journal of Gastroenterology
Volume23
Issue number23
DOIs
StatePublished - Jun 21 2017

Fingerprint

Acute Liver Failure
Necrosis
Liver
Chemical and Drug Induced Liver Injury
Autoimmune Hepatitis
Hepatitis
Biopsy
Survival
Transplants
Liver Transplantation
Survival Rate
Hepatitis Viruses
Virus Diseases
Mortality

Keywords

  • Biopsy
  • Fulminant liver failure
  • Histopathology
  • Liver transplantation
  • Massive necrosis
  • Submassive necrosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Substantial hepatic necrosis is prognostic in fulminant liver failure. / Ndekwe, Paul; Ghabril, Marwan; Zang, Yong; Mann, Steven A.; Cummings, Oscar; Lin, Jingmei.

In: World Journal of Gastroenterology, Vol. 23, No. 23, 21.06.2017, p. 4303-4310.

Research output: Contribution to journalArticle

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abstract = "AIM to evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival. METHODS Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived. RESULTS The core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26{\%}-75{\%} of the parenchymal volume) and 26 massive (76{\%}-100{\%}) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40{\%}, 71.4{\%} and 100{\%} in groups with necrosis of 76{\%}-100{\%}, 51{\%}-75{\%} and 26{\%}-50{\%}, respectively). Additionally, transplantfree survival rates were 66.7{\%}, 57.1{\%}, and 25.0{\%} in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80{\%}, 100{\%}, and 40{\%} in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively). CONCLUSION Adequate liver biopsy with more than 75{\%} necrosis is associated with significant transplant-free mortality that is critical in predicting survival.",
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AU - Ghabril, Marwan

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AU - Mann, Steven A.

AU - Cummings, Oscar

AU - Lin, Jingmei

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N2 - AIM to evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival. METHODS Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived. RESULTS The core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplantfree survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively). CONCLUSION Adequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.

AB - AIM to evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival. METHODS Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived. RESULTS The core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplantfree survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively). CONCLUSION Adequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.

KW - Biopsy

KW - Fulminant liver failure

KW - Histopathology

KW - Liver transplantation

KW - Massive necrosis

KW - Submassive necrosis

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