Background & Aims: Liver biopsy (LB) is performed if non-invasive work-up of liver disease is inconclusive.
The examination of liver tissue not infrequently reveals normal histology. Long term
follow-up of such patients has not been performed.
Methods: We identified a total 70 subjects from our LB database with elevated liver function
tests (eLFT) and normal liver histology after a mean of 90.5 ± 52.3 (range 15 – 216)
months by reassessment of medical history, physical examination, laboratory testing,
ultrasound, transient elastography and LB if indicated.
Results: At follow-up examination, fifteen (7 males/8 females; 21.4%) subjects had normal
LFT and no further evidence of liver disease. A subset of thirty-seven (29/8; 52.9%)
subjects had persistently eLFT without evidence indicating progressive liver disease
but the cause thereof remained unexplained also at the follow-up visit. Three (0/3;
4.3%) subjects had consumed excessive alcohol with indicators of alcoholic liver disease.
Eleven subjects (4/7; 15.7%) had developed steatosis on ultrasound examination along
with weight gain and/or biochemical features of the metabolic syndrome. Additionally,
2 female patients developed autoimmune hepatitis, 1 presented with primary biliary
cirrhosis, another male was diagnosed with cholangiocellular carcinoma. Conclusion: In approximately 1 out of 5 subjects, eLFT may be an early indicator of subsequent
liver disease missed on the index LB. Attention should be applied to autoimmune liver
diseases in women. Additionally, eLFT may herald consecutive hepatic steatosis if
accompanied by weight gain and components of the metabolic syndrome.
