T1017 Longitudinal Histologic Evidence of Loss of Steatosis with Progression of NAFLD to Cirrhosis and Liver Transplantation

Clark, Mary Elizabeth; Ghotb, Alireza; Merriman, Raphael B.

doi:10.1016/s0016-5085(09)63904-4

Cited by 6 publications

(3 citation statements)

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“…A portion of these cases is attributed to non-alcoholic steatohepatitis (NASH), since, when cirrhosis is established, patients no longer present typical histological characteristics of NASH, thus, preventing its clinical recognition (1,8,24) . A causal relationship between both entities could be suggested by the study of risk factors for NASH in patients with CC and/or by following NASH cases with serial liver biopsies (4,7,9,16,17,22,23,26,27,30,31) .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis

Leite

Mattos

Coral

et al. 2012

Arq. Gastroenterol.

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-Context -In about 10% of patients with chronic liver disease, it is not possible to identify an etiologic factor. These cases are called cryptogenic cirrhosis. Currently, nonalcoholic steatohepatitis (NASH) is being considered as a possible etiologic factor for a significant segment of patients that presents with cryptogenic cirrhosis. Objective -To estimate the prevalence of risk factors for NASH in patients with cryptogenic cirrhosis, in order to verify if there is a causal relationship between them. Method -Cross-sectional study, with evaluation of the demographic and laboratorial data of patients with cryptogenic cirrhosis. They were compared with data obtained from a group with NASH and a group with alcoholic and/or hepatitis C (HCV) cirrhosis. Results -Forty seven patients with cryptogenic cirrhosis were evaluated, 47 with NASH and 196 with HCV and/or alcoholic cirrhosis. The mean age of patients with cryptogenic cirrhosis was 52 years, while in those with NASH it was 46.4 years (P = 0,041). The group with cryptogenic cirrhosis had 23 female and 24 male patients. Of the patients who presented with NASH, 68.1% were female. Of the patients who presented with alcoholic/HCV cirrhosis, 64.8% were male. There were no statistically significant differences between the groups. In cryptogenic cirrhosis patients, the following prevalences could be observed: impaired fasting glycemia -68.2%; obesity -27.5%; total hypercholesterolemia -27.9%; low HDL levels -58.1% (women -81%; men -36.4%); hypertriglyceridemia -16.3%. The results seen in cryptogenic cirrhosis patients showed statistical similarity with the results of the NASH group regarding fasting glycemia (62.8%) and male HDL levels (53.8%). The comparison with the alcoholic/HCV cirrhosis group showed statistical differences regarding fasting glycemia (45.2%), hypercholesterolemia (13.3%) and female HDL levels (50.8%). Conclusions -It is not possible to establish a causal relationship between cryptogenic cirrhosis and NASH. Only data related to fasting glycemia and HDL levels in male patients showed statistical similarities between both groups of patients. HEADINGS -Liver cirrhosis. Fatty liver. Metabolic diseases.Declared conflict of interest of all authors: none.

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Section: Introductionmentioning

confidence: 99%

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis

Leite

Mattos

Coral

et al. 2012

Arq. Gastroenterol.

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“…But understanding the findings of the histological examination under these circumstances demands tight collaboration between the physician and the pathologist to ensure correct evaluation. Researchers have reported identifying remanent histological observations in cases with previous biopsy displaying incontrovertible NASH that have undergone re-evaluation for advanced stage cirrhosis with inadequate indicators for a steatohepatitis diagnosis (30)(31)(32). In such cases, macrosteatosis foci, cellular ballooning as well as glycogenated nuclei persist as remnants of previous steatohepatitis in cirrhotic cases where biopsy was deficient of definite indicators for NASH but that showed a compatible medical history and a previous biopsy demonstrating clear NASH.…”

Section: Discussionmentioning

confidence: 99%

inical Characteristics, Evaluation, Treatment, and Prognosis of Cryptogenic Cirrhosis

Ghamdi¹,

Bawareth²,

Alqufayi³

et al. 2022

JOHS

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The term cryptogenic cirrhosis (CC) implies that the underlying etiology is uncertain and devoid of definitive clinical, serological, and histological criteria for a specific type of cirrhosis. CC denotes a spectrum of underlying causes, among whom, the majority of evidence implicates non-alcoholic steatohepatitis (NASH) led progression as the most frequent route. CC is held accountable for around 5% of cirrhosis cases today. Cirrhosis complications like liver failure and hepatocellular carcinoma appear as the first presenting feature of the disease, as in other hepatic diseases. The hepatocarcinogenic risk of CC is substantial, with hepatocellular carcinoma’s reported annual cumulative incidence ranging between 2.6% to 3.5%. The diagnosis of CC relies on the exclusion of distinctly recognizable diseases and involves a careful clinical assessment including risk history and family history, followed by laboratory testing including serology, autoantibodies, immunoglobulin concentrations, biomarkers for Wilson’s disease and Celiac disease, and lastly histological assessment for the prominent type and inflammation distribution, and typical presenting features of cirrhotic tissues. The definitive treatment of CC involves transplantation. In cases suspected to be linked with NASH, medical management until transplantation can be beneficial to the patient. The management of CC involves collaboration of primary care with gastroenterology, hepatology, and transplant consultation, and nutritional counseling. Data regarding survival post-transplantation is limited and has shown conflicting results.

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“…Obesity must be sought in the history due to cirrhosis-related nutritional changes -loss of body fat in advanced cirrhosis can be striking and can obscure this relationship [27] . Histologically, residual cellular ballooning and glycogenated nuclei serve as clues to prior NASH [28,29] . About one half of the patients present with complications of portal hypertension and it is a common indication for liver transplantation, estimated to account for 5-10% of liver transplants.…”

Section: Cryptogenic Cirrhosismentioning

confidence: 99%

The Natural History of Non-Alcoholic Fatty Liver Disease

Caldwell¹,

Argo²

2010

Dig Dis

156

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Non-alcoholic fatty liver disease has a variable prognosis which is predictable to an extent based on the presence or absence of histological liver injury. Past studies have determined a number of clinical and laboratory parameters which predict greater severity on the initial biopsy, although all of these measures have limitations and biopsy remains the gold standard at this time. For patients with early stage non-alcoholic steatohepatitis (NASH), about one third will progress to stage 3 or 4 (cirrhosis) over 5–10 years. Thus, early-stage NASH constitutes one of the groups most likely to benefit from treatments now undergoing investigation. Among those who progress to NASH cirrhosis, about 25% will develop major complications of portal hypertension within 3 years. In contrast, non-NASH fatty liver tends to be stable over time, although there appears to be an increased cancer risk in all forms of fatty liver, albeit greater in NASH compared to non-NASH fatty liver. Interestingly, the cause of death among patients with NASH is more often due to cardiovascular disease or non-liver malignancy than cirrhosis. However, the accelerated risk of cirrhosis in this group compared to cardiovascular disease suggests that this picture is likely to change in the foreseeable future. Meanwhile, the relationship between these comorbidities will increasingly lead to patients with both coronary disease or malignancy and NASH-related cirrhosis presenting clinicians with a very challenging set of problems in coming years.

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T1017 Longitudinal Histologic Evidence of Loss of Steatosis with Progression of NAFLD to Cirrhosis and Liver Transplantation

Cited by 6 publications

References 0 publications

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis

inical Characteristics, Evaluation, Treatment, and Prognosis of Cryptogenic Cirrhosis

The Natural History of Non-Alcoholic Fatty Liver Disease

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