title: Mini-laparoscopy guided liver biopsy increases diagnostic accuracy in acute liver failure.
abstract: OBJECTIVE
  For diagnosis, prognosis, and treatment of acute liver failure (ALF), macroscopic evaluation and histological assessment of the liver are important. Due to impaired coagulation in ALF, the risk of bleeding is high after a percutaneous liver biopsy. Our aims were to assess (i) safety and benefit of mini laparoscopy (ML) in patients with ALF and (ii) the potential utility of histological markers in ALF prognosis.
  
  
  METHODS
  ML was performed in 39 patients with ALF to assess liver surface and to obtain a liver biopsy. Serological markers of liver injury and immunohistochemical detection of cell death and proliferation were compared to a non-ALF group (n = 10).
  
  
  RESULTS
  Liver biopsies were successfully performed in all patients with no significant complications. All patients had markedly elevated M30 and M65 levels in the serum. In the liver, M30 and Ki67 immune-reactive cells were more abundant in those with ALF. Importantly, there were significantly more Ki67-positive cells but fewer M30-positive cells in livers of ALF patients who recovered spontaneously.
  
  
  CONCLUSIONS
  ML with liver biopsy in patients with ALF and severe coagulopathy is safe. Immunohistochemical detection of liver cell death and regeneration may identify individuals who would recover spontaneously or who would need a liver transplant.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechêne
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Sowa
authors.forename: Martin
authors.initials: M
authors.lastname: Schlattjan
authors.forename: Alexander
authors.initials: A
authors.lastname: Wree
authors.forename: Sandra
authors.initials: S
authors.lastname: Blomeyer
authors.forename: Jan
authors.initials: J
authors.lastname: Best
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Maldonado
authors.forename: Lars P
authors.initials: LP
authors.lastname: Bechmann
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Hideo A
authors.initials: HA
authors.lastname: Baba
authors.forename: Wing-Kin
authors.initials: WK
authors.lastname: Syn
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D001778:Blood Coagulation Disorders / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D053538:Keratin-18 / Q000378:metabolism; D019394:Ki-67 Antigen / Q000378:metabolism; D010535:Laparoscopy / Q000379:methods; D008099:Liver / Q000378:metabolism / Q000473:pathology*; D017114:Liver Failure, Acute / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D012075:Remission, Spontaneous; D055815:Young Adult
chemical_list: D053538:Keratin-18; D019394:Ki-67 Antigen; C561463:M30 cytokeratin-18 peptide, human; C577325:M65 antigen, human; D010446:Peptide Fragments