Original ArticlesHeterogeneity of Fibrosis in Liver Biopsies of Patients With Heart Failure Undergoing Heart Transplant EvaluationDhall, Deepti MD*; Kim, Stacey A. MD*; Mc Phaul, Christopher MD*; Kransdorf, Evan P. MD, PhD†; Kobashigawa, Jon A. MD†; Sundaram, Vinay MD, MSc‡; Mirocha, James MS§; Guindi, Maha MD, FRCPC*Author Information *Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center §Biostatistics Core, Cedars-Sinai Medical Center †Smidt Heart Institute, Cedars-Sinai Medical Center ‡Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Deepti Dhall, MD, Department of Pathology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048 (e-mail: [email protected]). The American Journal of Surgical Pathology: December 2018 - Volume 42 - Issue 12 - p 1617-1624 doi: 10.1097/PAS.0000000000001163 Buy Metrics Abstract Liver biopsies are commonly performed in heart transplant candidates to confirm congestive hepatopathy (CH) and to assess the degree of fibrosis. Heterogeneity of fibrosis is frequent in CH, making it difficult to stage fibrosis. In this study, we evaluated the prevalence of heterogeneity of fibrosis and nodular regenerative hyperplasia (NRH) in liver biopsies with CH secondary to heart failure. Fifty liver biopsies with CH secondary to heart failure were reviewed. The fibrosis was scored on trichrome stain as follows: stage 0 for no fibrosis, stage 1 for zone 3 fibrosis, stage 2 for zone 3 and portal fibrosis, stage 3 for bridging fibrosis, and stage 4 for cirrhosis. Both stage 3 and stage 4 fibrosis were classified as advanced fibrosis. A predominant pattern of fibrosis and a secondary pattern of fibrosis, defined as a different stage of fibrosis seen in at least 10% of the biopsy material, if present, were recorded. A biopsy was considered to show heterogenous fibrosis if there was at least a 2 stage difference between the predominant and secondary patterns. Thirteen biopsies (26%) showed heterogenous fibrosis. Sixteen biopsies (32%) showed some evidence of advanced fibrosis: 5 had uniform advanced fibrosis, 4 had predominant pattern of advanced fibrosis, and advanced fibrosis was focal in 7 biopsies from 6 patients. NRH-type changes were seen in 9 of 50 biopsies (18%). In conclusion, our study showed heterogenous fibrosis in the liver biopsy of a quarter of patients with CH due to heart failure, highlighting the limitations of fibrosis assessment in the biopsies, and suggests that correlation with the complete clinical information is essential for management decisions. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.