title: Contribution of transjugular liver biopsy in patients with the clinical presentation of acute liver failure.
abstract: OBJECTIVE
  Acute liver failure (ALF) treated with conservative therapy has a poor prognosis, although individual survival varies greatly. In these patients, the eligibility for liver transplantation must be quickly decided. The aim of this study was to assess the role of transjugular liver biopsy (TJLB) in the management of patients with the clinical presentation of ALF.
  
  
  METHODS
  Seventeen patients with the clinical presentation of ALF were referred to our institution during a 52 month period. A TJLB was performed using the Cook Quick-Core needle biopsy. Clinical data, procedural complications, and histologic findings were evaluated.
  
  
  RESULTS
  Causes of ALF were virus hepatitis B infection in 7 patients, drug toxicity in 4, mushroom in 1, Wilson's disease in 1, and unknown origin in 4. TJLB was technically successful in all patients without procedure-related complications. Tissue specimens were satisfactory for diagnosis in all cases. In 14 of 17 patients the initial clinical diagnosis was confirmed by TJLB; in 3 patients the initial diagnosis was altered by the presence of unknown cirrhosis. Seven patients with necrosis < 60% were successfully treated with medical therapy; 6 patients with submassive or massive necrosis (> or = 85%) were treated with liver transplantation. Four patients died, 3 had cirrhosis, and 1 had submassive necrosis. There was a strict statistical correlation (r = 0.972, p < 0.0001) between the amount of necrosis at the frozen section examination and the necrosis found at routine histologic examination. The average time for TJLB and frozen section examination was 80 min.
  
  
  CONCLUSIONS
  In patients with the clinical presentation of ALF, submassive or massive liver necrosis and cirrhosis are predictors of poor prognosis. TLJB using an automated device and frozen section examination can be a quick and effective tool in clinical decision-making, especially in deciding patient selection and the best timing for liver transplantation.
authors.affiliation: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy. rmiraglia@ismett.edu
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Marta Ida
authors.initials: MI
authors.lastname: Minervini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vizzini
authors.forename: Antonio
authors.initials: A
authors.lastname: Arcadipane
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D047508:Massive Hepatic Necrosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome