Right and left liver lobe biopsies by minilaparoscopy reveal clinically significant sampling error in staging and grading of autoimmune hepatitis
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Right and left liver lobe biopsies by minilaparoscopy reveal clinically significant sampling error in staging and grading of autoimmune hepatitis. / Johannes, Hartl; Malte, Wehmeyer; Alali, Shaima; Marcial, Sebode; Sören, Weidemann; Ptashynska, Anastasiya ; Christina, Weiler-Normann; Christoph, Schramm; Willhelm, Lohse Ansgar; Till, Krech; Jörg, Schrader.
in: LIVER INT, Jahrgang 43, Nr. 6, 06.2023, S. 1269-1276.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Right and left liver lobe biopsies by minilaparoscopy reveal clinically significant sampling error in staging and grading of autoimmune hepatitis
AU - Johannes, Hartl
AU - Malte, Wehmeyer
AU - Alali, Shaima
AU - Marcial, Sebode
AU - Sören, Weidemann
AU - Ptashynska, Anastasiya
AU - Christina, Weiler-Normann
AU - Christoph, Schramm
AU - Willhelm, Lohse Ansgar
AU - Till, Krech
AU - Jörg, Schrader
N1 - © 2023 The Authors. Liver International published by John Wiley & Sons Ltd.
PY - 2023/6
Y1 - 2023/6
N2 - BACKGROUNDS/AIMS: Liver diseases may affect the liver heterogeneously, especially in autoimmune hepatitis (AIH). Hence, the aim of this study was to assess the added benefit of double biopsy of both liver lobes during minilaparoscopy in guiding treatment decisions in patients with AIH.METHODS: We identified all patients with AIH or variant syndromes (AIH/PBC and AIH/PSC) at our center, who underwent a double biopsy of both liver lobes via minilaparoscopy between 01/2016 and 12/2020.RESULTS: A total of 114 patients received a biopsy of both liver lobes (AIH: N = 83, AIH/PBC: N = 26, AIH/PSC: N = 7). Differences in inflammatory activity as assessed by Ishaks's modified hepatitis activity index (mHAI) were observed in 72 (63%) patients. The difference was ≥2/18 points and ≥3/18 points in 32 (28%) and 11 (10%) patients, respectively. Starting or intensification of immunosuppression should be discussed at a mHAI of 4-5, while a mHAI≥6 prompts intensified immunosuppression in most cases. In 19/114 (17%) and 17/114 (15%) patients mHAI ≥4 or ≥6 was found in only one liver lobe, respectively. In ten patients, severe fibrosis (≥F3) was only found in one liver biopsy. Overall, therapeutically relevant histological differences were observed in 39/114 (34%) patients, which had a direct impact on treatment decisions in 24 patients (21%). No major adverse outcome occurred by taking biopsies from both liver lobes.CONCLUSIONS: Obtaining a double biopsy of both liver lobes is a safe procedure during minilaparoscopy that results in more accurate grading and staging and that may impact on treatment decisions in patients with AIH.
AB - BACKGROUNDS/AIMS: Liver diseases may affect the liver heterogeneously, especially in autoimmune hepatitis (AIH). Hence, the aim of this study was to assess the added benefit of double biopsy of both liver lobes during minilaparoscopy in guiding treatment decisions in patients with AIH.METHODS: We identified all patients with AIH or variant syndromes (AIH/PBC and AIH/PSC) at our center, who underwent a double biopsy of both liver lobes via minilaparoscopy between 01/2016 and 12/2020.RESULTS: A total of 114 patients received a biopsy of both liver lobes (AIH: N = 83, AIH/PBC: N = 26, AIH/PSC: N = 7). Differences in inflammatory activity as assessed by Ishaks's modified hepatitis activity index (mHAI) were observed in 72 (63%) patients. The difference was ≥2/18 points and ≥3/18 points in 32 (28%) and 11 (10%) patients, respectively. Starting or intensification of immunosuppression should be discussed at a mHAI of 4-5, while a mHAI≥6 prompts intensified immunosuppression in most cases. In 19/114 (17%) and 17/114 (15%) patients mHAI ≥4 or ≥6 was found in only one liver lobe, respectively. In ten patients, severe fibrosis (≥F3) was only found in one liver biopsy. Overall, therapeutically relevant histological differences were observed in 39/114 (34%) patients, which had a direct impact on treatment decisions in 24 patients (21%). No major adverse outcome occurred by taking biopsies from both liver lobes.CONCLUSIONS: Obtaining a double biopsy of both liver lobes is a safe procedure during minilaparoscopy that results in more accurate grading and staging and that may impact on treatment decisions in patients with AIH.
KW - Humans
KW - Hepatitis, Autoimmune
KW - Liver Cirrhosis, Biliary
KW - Selection Bias
KW - Biopsy
U2 - 10.1111/liv.15583
DO - 10.1111/liv.15583
M3 - SCORING: Journal article
C2 - 37066519
VL - 43
SP - 1269
EP - 1276
JO - LIVER INT
JF - LIVER INT
SN - 1478-3223
IS - 6
ER -