Fibrosis quantification in alcoholic liver disease: a histological-hemodynamic study

Background The relationship between portal pressure and architectural distortion in general, and fibrosis in particular, remains ill defined in patients with chronic liver diseases. We performed a morphometric analysis of fibrosis using a computer assisted method on liver biopsy specimens obtained during transjugular liver biopsy in 19 consecutive patients admitted for decompensated alcoholic liver disease. The hepatic venous pressure gradient (HVPG) was obtained in all patients. Liver biopsy was performed using a TJL 9F aspiration type needle (Cook), with a mean 2.5 passes. Mean fibrosis area (MFA) was expressed as the percentage of the total area of liver tissue specimen. Results Patients characteristics are given in Table (median, range). Liver biopsy provided fragmented samples but were appropriate for a complete histological evaluation in all cases. Cirrhosis was diagnosed in all patients, but the number and thickness of fibrous septa were variable among cases. n 19 Age (yrs) 55 [35-69] Histological criteria for alcoholic steatohepatitis 10/19 HVPG (mmHg) 17 [4-23] MFA (%) 11.5 [2-42] Cirrhosis (%) 100 MELD score 18.5 MFA showed a weak correlation with portal pressure, as assessed by HVPG (r=0.29), and with the wedge hepatic pressure (r=0.21). Conclusions In patients with decompensated alcoholic liver disease, fibrosis area measured by morphometry on liver biopsy specimens correlates poorly with portal pressure. We hypothesized that fragmentation of liver tissue in relation with the transvenous aspiration technique, the sampling variability, as well as the dynamic vascular component of portal hypertension overexpressed in alcoholic steatohepatitis may explain in part these results.