Histopathology and clinical correlates of end‐stage hepatitis B cirrhosis: A possible mechanism to explain the response to antiviral therapy

In chronic liver disease associated with histological necroinflammation, clinical severity is frequently greater in those with higher grades of activity. Conventional wisdom assumes that necroinflammation is mild or absent in patients with end‐stage hepatitis B virus (HBV) cirrhosis due to the frequ...

Full description

Saved in:
Bibliographic Details
Published in:Liver transplantation 2005-01, Vol.11 (1), p.82-88
Main Authors: Sigal, Samuel H., Ala, Aftab, Ivanov, Katya, Hossain, Sabera, Bodian, Carol, Schiano, Thomas D., Min, Albert D., Bodenheimer, Henry C., Thung, Swan N.
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Antiviral Agents - administration & dosage
Bilirubin
Cirrhosis
DNA
DNA, Viral - blood
Ethnic groups
Female
hepatitis B core antigen
hepatitis B e antigen
Hepatitis B e Antigens - genetics
Hepatitis B virus
Hepatitis B, Chronic - drug therapy
Hepatitis B, Chronic - pathology
Hepatitis B, Chronic - surgery
Humans
Immunohistochemistry
Inflammation
Liver
Liver Cirrhosis - pathology
Liver Cirrhosis - surgery
Liver diseases
Liver Transplantation
Male
Middle Aged
Severity of Illness Index
Transaminases - blood
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:In chronic liver disease associated with histological necroinflammation, clinical severity is frequently greater in those with higher grades of activity. Conventional wisdom assumes that necroinflammation is mild or absent in patients with end‐stage hepatitis B virus (HBV) cirrhosis due to the frequent presence of mildly elevated aminotransferase levels, the absence of hepatitis B e antigen (HBeAg), and low or undetectable HBV deoxyribonucleic acid (DNA) levels. However, a histopathologic analysis of such patients has not been undertaken. The aims of this study were 1) to assess severity and histological features of inflammation, 2) to correlate the severity of inflammation with biochemical and virologic parameters, and 3) to define the relationship between inflammation and clinical severity in explanted livers from patients undergoing liver transplantation for HBV cirrhosis. Characteristics of 34 consecutive patients undergoing liver transplantation for HBV cirrhosis were correlated with inflammation and immunohistological findings in the explanted livers. High‐grade inflammation (grades 3 and 4) was found in many cases (47.1% interface hepatitis; 14.8% lobular inflammation; and 20.6% portal inflammation). The presence of positive cytoplasmic staining for hepatitis B core antigen (HBcAg) was associated with grade 3 or 4 interface hepatitis (P = .046) and lobular hepatitis (P = .005). There was no correlation between inflammatory activity and age, Asian ethnicity, aminotransferase levels, total bilirubin levels, HBeAg seropositivity, and detectable HBV DNA level. Patients with high‐grade inflammation had greater degrees of hepatic decompensation. In conclusion, high‐grade inflammation is common in end‐stage HBV cirrhosis, but it is not readily detected by biochemical and virologic parameters. High‐grade inflammation is associated with a greater degree of hepatic decompensation. (Liver Transpl 2005;11:82–88.)
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.20328