Acute liver failure histopathology: A 5-year retrospective study

Area of Science:

• Hepatology
• Pathology
• Internal Medicine

Background:

• Acute liver failure (ALF) is a rare, severe liver injury without pre-existing disease, characterized by impaired synthetic function and encephalopathy.
• Diagnosis relies on clinical presentation, with diverse underlying causes and varied pathological features.
• Histological examination plays a role in identifying the etiology of ALF.

Purpose of the Study:

• To explore diverse histological patterns in acute liver failure (ALF) cases.
• To assess the utility of these histological patterns in determining the underlying causes of ALF.
• To specifically analyze morphological features in autoimmune hepatitis-associated ALF.

Main Methods:

• A retrospective cross-sectional study of 22 ALF cases (10 explants, 12 biopsies) over five years.
• Review of clinical, laboratory, and histological findings.
• Comparative morphological evaluation of autoimmune hepatitis (AIH) ALF cases against other ALF etiologies.

Main Results:

• Virus-induced liver damage was the most common cause (36.3%), followed by autoimmune hepatitis (22.7%) and drug-induced liver injury (18.1%).
• Six distinct histological patterns were identified.
• Portal plasma cell infiltrate and central perivenulitis were significant histological indicators in AIH-related ALF.

Conclusions:

• Histological patterns in ALF show morphological overlap, complicating etiological assessment.
• Specific features, such as portal plasma cells, are key diagnostic indicators for autoimmune hepatitis in ALF.
• Histopathology is valuable for guiding the diagnosis of ALF causes.