Diabetic hepatosclerosis: a 10-year autopsy series

Diabetic hepatosclerosis (DHS), recently described in liver biopsies in insulin-dependent diabetes mellitus, is characterized by dense perisinusoidal collagen.

To evaluate prevalence of DHS in an autopsy series of diabetic patients.

Liver slides and clinical charts from autopsied diabetics from 1997 to 2007 were reviewed. Exclusions were nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, cirrhosis of any cause, cardiac sclerosis and marked autolysis.

Of 976 autopsies in the 10-year period, 254 had DM, and 159 met criteria for inclusion. Nineteen cases (12%) met criteria of DHS. In contrast to the findings in the recently published series of 14 clinically indicated biopsies, the affected autopsy patients were more often men than women (14:5), were older (mean age 56.4 vs 45.8 years), and had less commonly recorded retinopathy and elevated alkaline phosphatase (16 and 32% vs 42 and 83%), respectively, but diabetic nephropathy was equally common (89 vs 83%). Compared with an age- and gender-matched group of autopsied diabetic patients without DHS, the DHS group had a significantly higher percentage of diabetic nephropathy (89 vs 47%, P<0.05); no other statistically significant clinical differences were found between these two groups.

DHS may represent a hepatic form of microvascular disease in DM; the prevalence of 12% in the autopsy series suggests it is not uncommon, but in the majority of the cases, it was clinically silent.