The aim of this study was to describe the histologic pattern of
iron distribution in end-stage
cirrhosis due to various causes and to test the reliability of the hepatic
iron index (equal to hepatic
iron concentration divided by age) in excluding or confirming associated
hemochromatosis in such a condition. Large slices of the resected livers of 30 patients transplanted for alcoholic and/or viral end-stage
cirrhosis were assessed histologically for
iron distribution and biochemically for hepatic
iron concentration in the least and the most
iron-overloaded nodules of each case.
HLA-A3 was used as the marker for the
hemochromatosis gene in the population studied. Intranodular parenchymal
siderosis was found in 23 cases (12 spotty, 11 diffuse) with diffuse intrabiliary
iron deposits apparent in only two cases. Although in 14 patients the hepatic
iron index was significantly high (> 1.9) so as to suggest
hemochromatosis, these cases did not correspond to homozygous
hemochromatosis with respect to the prevalence of
HLA-A3 antigen. End-stage
cirrhosis arising from different causes is frequently complicated by parenchymal
siderosis that may mimic
hemochromatosis, including a hepatic
iron index greater than 1.9. The diagnosis of
hemochromatosis in patients with end-stage
cirrhosis, even those with a hepatic
iron index greater than 1.9, should rely mainly on clinical and histologic data.