S1877 Loss of Autophagy Enhances Acetaminophen-Induced Liver Injury

Abstract

Objectives: To study the etiology, pathogenesis, prevalence and treatment patterns of hepatic granulomas in a single center. Background: Hepatic granulomas are frequently seen in patients who undergo liver biopsy. We reviewed our experience with hepatic granulomas to determine the etiology, demographics and treatment patterns in our institution. Methods: Data were collected from medical records of patients diagnosed with granulomatous hepatitis by liver biopsy at Saint Louis University between January 2002 and December 2008. Etiology was determined using history and clinical data, pathology report and liver tissue polymerase chain reaction when needed. SPPS data was used for descriptive analysis. For quantitative variables, mean and +/-SD were calculated. Results: 10291 liver biopsies were reviewed, inhouse and consult. There were 185 patients with hepatic granulomas. Of these, 130 (70.3%) were female and 55 (29.7%) male. 124 (67%) were Caucasian, 53 (28.6%) were AfricanAmerican. Fifty-one (27.6%) patients were asymptomatic at the time of presentation, with elevation of liver enzymes as the main reason to undergo liver biopsy. 126 (68.1%) of patients had symptoms, with fatigue (30.8%) the most common one. Data was incomplete for 8 patients. In 163 cases (88.1%) a definitive diagnosis was established. Primary biliary cirrhosis (PBC) was the most common diagnosis in 38 patients (20.5%) although, when considering all the autoimmune liver diseases including PBC, overlap and autoimmune hepatitis was 57 (30.8%), followed by sarcoidosis with 36 cases (19.5%), 26 (15.9%) Hepatitis C, 12 (7.3%) related to drugs. Liver biopsy findings are as follows: 24 (13%) had cirrhosis, 75% of pts had mild to moderate inflammatory activity (Grade 1 and Grade 2) and 18% Grade 3. The location of the granuloma was portal in most cases (42.2%), then lobular (21.2%) and both (32.2%). Seventy-two (38.9%) of cases had bile duct damage and 58 patients (38.9%) had cholestasis. The most commonly used form of treatment regardless of diagnosis was ursodiol in 50 patients (27%), followed by immunosuppression in 44 (23.7%), none in 33(17%). Fifteen patients received liver transplantation. Conclusion: Similar studies performed in Western countries have showed granulomas are most commonly seen in autoimmune liver diseases and the incidence of infection is a rare finding (1.6%). The symptoms in the majority of patients (79.4%) after follow-up for an average of 3.4 years had improved or remained unchanged.