Original ContributionsCryptogenic cirrhosis: Clinicopathologic findings at and after liver transplantation*
Section snippets
Patient population
During the period of 16.5 years from July 1983 to December 1999, 534 patients underwent LT (cadaveric, 532; live donor, 2) in our program. Twenty-seven (5%) of these 534 patients entered in the LT database as cases of CC constituted our study cases.
Histopathologic evaluation
A detailed histologic evaluation of all liver specimens (native and allograft biopsies), was performed by 2 pathologists (G.A. and U.K.) without prior knowledge of clinical information. Special stains for fibrous tissue (trichrome), reticulin, and
Results
The 27 cases could be broadly categorized into 4 groups. These were nonalcoholic steatohepatitis (NASH), autoimmune liver disease (AILD), “other” etiologic processes, and unresolved. Some cases from each category had clinical and/or pathologic features suggestive of more than 1 underlying pathogenetic mechanisms. These were assigned to a group based on the predominant pathologic features. The demographic, clinical, serologic, and pathologic features are listed in Tables 1 and 2.
Discussion
The 5% incidence of CC available from our transplant database is similar to that recently reported in the literature. However, some authors7 believe that the frequency of this diagnosis is truly uncertain, because it may reflect different geographic distribution, referral patterns, and, most of all, the extent of clinical investigative efforts. This explains the variability of diagnosis implicated in the pathogenesis of CC in previous studies.8, 9, 10, 11, 12 Some of the possible causes of CC
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2018, Annals of Diagnostic PathologyCitation Excerpt :As disease progresses, steatosis, ballooning, and inflammation dissipate [31]. In addition, cryptogenic cirrhosis patients are more likely to have metabolic syndrome/obesity [32,33], and NASH often recurs in post-transplant livers [34]. These observations have formed the main argument for linking cryptogenic cirrhosis to NASH.
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Address correspondence and reprint requests to Urmila Khettry, MD, Department of Pathology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805.