Mini-Laparoscopy Guided Liver Biopsy Increases Diagnostic Accuracy in Acute Liver Failure

Dechêne, Alexander; Sowa, Jan-Peter; Schlattjan, Martin; Wree, Alexander; Blomeyer, S.; Best, Jan; Maldonado, Evelyn J; Bechmann, Lars P.; Gerken, Guido; Baba, Hideo A.; Syn, Wing–Kin; Canbay, Ali

doi:10.1159/000366517

Cited by 22 publications

(17 citation statements)

References 23 publications

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“…In our patient cohort, we could show that liver biopsies of AIH-ALF patients contained more often than biopsies of cAIH patients, typical for AIH histopathological findings. In addition, we did not observe any liver biopsy-related complications, underlining the importance and safety of liver biopsy in an ALF of unknown etiology setting as described before [14]. …”

Section: Discussionsupporting

confidence: 77%

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Corticosteroid Therapy Improves the Outcome of Autoimmune Hepatitis-Induced Acute Liver Failure

et al. 2018

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Background/Aims: Autoimmune hepatitis (AIH) is a relatively rare cause of liver dysfunction and may lead in some cases to acute liver failure (ALF). The aim of our study was to evaluate the clinical course and outcome of patients with AIH-induced ALF. Methods: We retrospectively enrolled 32 patients with AIH-induced ALF and 93 age- and sex-matched patients with chronic AIH (cAIH) who were enrolled at the University Clinic Essen from 1988 to 2014. All ALF patients were treated with corticosteroids after diagnosis. Results: Overweight, higher γ-globulin levels, the absence of anti-smooth muscle antibodies and human leukocyte antigen (HLA) B8 and the presence of anti-mitochondrial antibodies and HLA DR7 were risk factors for an ALF vs chronic hepatitis manifestation of AIH. Liver histology was significantly more often typical for AIH in an ALF setting than in cAIH. The spontaneous survival rate was 91% and 97% in ALF and cAIH patients, respectively, at 6 months after diagnosis and only 1 patient in the ALF group developed sepsis under therapy. Conclusion: Liver biopsy in an AIH-mediated ALF setting was both safe and effective in diagnosing AIH. Corticosteroid therapy was not associated with high mortality or sepsis. Our findings suggest that corticosteroid treatment of AIH-mediated ALF may improve the outcome.

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Section: Discussionsupporting

confidence: 77%

“…Liver biopsy was performed either percutaneously or laparoscopically as described before [14]. Liver biopsy specimens were ﬁxed in formalin and embedded in paraffin.…”

Section: Methodsmentioning

confidence: 99%

Corticosteroid Therapy Improves the Outcome of Autoimmune Hepatitis-Induced Acute Liver Failure

et al. 2018

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“…While decompensated liver cirrhosis is easy to detect clinically, the diagnosis of compensated stages of ACLD may be more challenging. The combination of macroscopic and microscopic assessments of the liver has previously been shown to be superior to the histological evaluation alone for the detection of fibrous changes [11,14,19] , most likely due to the sampling error generated by just one liver biopsy [4] . Accordingly, laparoscopy revealed a significant number of patients in our care suffering from severe fibrosis or cirrhosis, but understaged by histology.…”

Section: Discussionmentioning

confidence: 99%

High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

Zizer

Backhus²,

Bohl³

et al. 2016

Digestion

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Background/Aim: The assessment of advanced chronic liver disease (ACLD) is a prerequisite for therapy and surveillance in patients with chronic hepatitis C infection. Mini-laparoscopy-assisted liver biopsies facilitate both histological and macroscopical evaluation of liver fibrosis. This study is aimed at investigating the prognostic significance of the laparoscopic assessment for the cumulative incidence of ACLD-related events. Patients and Methods: We performed a single center, retrospective analysis of 94 patients with either macroscopically or/and microscopically assessed advanced fibrosis/cirrhosis caused by chronic hepatitis C infection. The patients' data, the respective laboratory results, and follow-up period were evaluated in the outpatient clinic. Results: The group with both macro- and microscopic diagnosed ACLD showed a significantly higher number of decompensating events (n = 7) compared with the other 2 groups (n = 0 in the group with only histological and n = 1 in the group with only laparoscopic diagnosis of advanced liver disease). The results were not affected by the successful treatment of the hepatitis C virus. In the Cox-regression analysis, the spleen size (>120 mm) was significantly associated with the incidence of ACLD-related events. Conclusions: Assessment of ACLD in chronic hepatitis C by mini-laparoscopy-assisted liver biopsies may facilitate the selection of patients with a poor prognosis, irrespective of achieving a sustained virological response following treatment. Follow-up of these patients should be intensified to treat decompensation early.

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“…In contrast, assessment of coagulation by rotational thromboelastometry suggests that despite a reduction of some coagulation factors, actual clotting may not be impaired in ALF [22] . In fact, we have shown 427 that biopsy via mini-laparoscopy, allowing visual control of the biopsy site and cauterization in case of bleeding, is a safe procedure and does not lead to increased bleeding complications [23] . In addition, this method opens up the possibility to histologically asses liver tissue, estimate damage and perform specific staining for further diagnostics.…”

Section: Novel Diagnostic Approachesmentioning

confidence: 99%

“…High numbers of apoptotic cells in combination with low numbers of cells positive for cell cycle progression were predominantly found in patients with adverse outcome (LTx required or death) [23] . This is in line with the hypothesis that the severity of damage to the liver tissue determines if hepatocyte proliferation only or additional proliferation of liver progenitor cells occurs.…”

Section: Novel Diagnostic Approachesmentioning

confidence: 99%

Acute Liver Failure - It's Just a Matter of Cell Death

Sowa

Gerken

Canbay³

2016

Dig Dis

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Background: Acute liver failure (ALF) is characterized by a sudden loss of hepatic function due to hepatocyte cell death and dysfunction in previously healthy individuals. The clinical presentation of ALF is associated with coagulopathy (international normalized ratio ≥1.5) and hepatic encephalopathy, although the latter may be less pronounced. Without appropriate and timely intensive care or liver transplantation (LTx), ALF will result in multi-organ failure and death. Various causes may induce ALF, with acetaminophen (APAP) intoxication and acute hepatitis B infection as most common causes in industrialized countries. While conventional terminology discerns acute, acute-on-chronic and acute-on cirrhosis liver failure, some chronic liver diseases (i.e. autoimmune hepatitis (AIH), Wilson's disease) can remain undiagnosed until an initial presentation as ALF. Key Messages: Upon definite diagnosis of ALF, the underlying cause must be identified, since etiology affects prognosis and clinical management. Individual prognosis should be evaluated with one of various available scoring systems. Most widely used are Model for End-Stage Liver Disease, the King's College Criteria and the Clichy criteria. Other markers, that is, cell death markers, lactate or thyroid status, may improve diagnostic accuracy of classic scores, though routine use of these is not yet established. Etiology-specific treatment under intensive care should be performed, if possible (APAP and amanita intoxication, acute viral hepatitides and AIH). LTx is the only curative option for other causes, unknown reasons of ALF or when etiology-specific therapy fails. In ambiguous cases, that is, suspected drug induced ALF or AIH, co-infection with hepatitis E virus should be tested, as this might be more common than it is currently supposed to be. Conclusions: Despite major improvements in clinical management of ALF patients, a significant proportion of ALF cases remains without clear identification of the underlying cause or unrecognized multiple causes. In depth analyzes of ambiguous ALF cases is warranted to further improve clinical management.

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Mini-Laparoscopy Guided Liver Biopsy Increases Diagnostic Accuracy in Acute Liver Failure

Cited by 22 publications

References 23 publications

Corticosteroid Therapy Improves the Outcome of Autoimmune Hepatitis-Induced Acute Liver Failure

Corticosteroid Therapy Improves the Outcome of Autoimmune Hepatitis-Induced Acute Liver Failure

High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

Acute Liver Failure - It's Just a Matter of Cell Death

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