Article
Open Access
Volume 5 · Issue 4 · 2025
pp. 167–173
Etiological Investigation of Cryptogenic Cirrhosis Patients Undergoing Liver Transplantation
Mahmut Kara1 
, Yonca Yılmaz Ürün1 , Oğuzhan Yıldırım2
, Yonca Yılmaz Ürün1 , Oğuzhan Yıldırım2
1
Department of Medical Oncology, Van Yuzuncu Yil University Faculty of Medicine, Van, Türkiye
2
Department of Medical Oncology, Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Türkiye
Abstract
Objectives: This study aimed to investigate hidden etiologies in patients with cryptogenic cirrhosis by evaluating post-liver transplantation explant pathology findings.
Methods: Between 2010 and 2018, 324 patients with cryptogenic cirrhosis from a total cohort of 2,400 were analyzed retrospectively. Pretransplant clinical scores, including FIB-4, APRI, Child, and MELD scores, and posttransplant pathol-ogy results were recorded. Patients diagnosed with NASH were further evaluated for body mass index (BMI) and diabe-tes mellitus (DM). Ascites and hepatocellular carcinoma (HCC) conversion rates were also analyzed.
Results: The mean age of the patients was 47.5±14.6 years. Posttransplant pathology identified specific etiologies in 58.3% of cases: NASH/NAFLD (24.7%), HCC (7.7%), veno-occlusive disease (6.8%), biliary pathology (5.2%), autoimmune hepatitis (4.3%), and Wilson’s disease (3%). Etiology remained undetermined in 135 patients (41.7%). Ascites was de-tected in 71.5% (n=232) of patients, and HCC was found in 17.3% (n=57). Among patients with NASH, 66.15% had DM/insulin resistance, and 72.5% had a BMI >25. The pretransplant mean Child and MELD scores were 12.1±1.4 and 28.5±5.3, respectively.
Conclusion: Explant pathology reveals that various diseases, particularly NASH/NAFLD, often underlie cryptogenic cir-rhosis. NASH should be investigated thoroughly in cases of metabolic syndrome. Additionally, occult HBV and veno-oc-clusive disease should be considered in unexplained cirrhosis, even when standard serology and imaging are negative.
Methods: Between 2010 and 2018, 324 patients with cryptogenic cirrhosis from a total cohort of 2,400 were analyzed retrospectively. Pretransplant clinical scores, including FIB-4, APRI, Child, and MELD scores, and posttransplant pathol-ogy results were recorded. Patients diagnosed with NASH were further evaluated for body mass index (BMI) and diabe-tes mellitus (DM). Ascites and hepatocellular carcinoma (HCC) conversion rates were also analyzed.
Results: The mean age of the patients was 47.5±14.6 years. Posttransplant pathology identified specific etiologies in 58.3% of cases: NASH/NAFLD (24.7%), HCC (7.7%), veno-occlusive disease (6.8%), biliary pathology (5.2%), autoimmune hepatitis (4.3%), and Wilson’s disease (3%). Etiology remained undetermined in 135 patients (41.7%). Ascites was de-tected in 71.5% (n=232) of patients, and HCC was found in 17.3% (n=57). Among patients with NASH, 66.15% had DM/insulin resistance, and 72.5% had a BMI >25. The pretransplant mean Child and MELD scores were 12.1±1.4 and 28.5±5.3, respectively.
Conclusion: Explant pathology reveals that various diseases, particularly NASH/NAFLD, often underlie cryptogenic cir-rhosis. NASH should be investigated thoroughly in cases of metabolic syndrome. Additionally, occult HBV and veno-oc-clusive disease should be considered in unexplained cirrhosis, even when standard serology and imaging are negative.
Keywords: Cryptogenic cirrhosis, liver transplantation, non-alcoholic fatty liver disease
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