Diabetic hepatosclerosis: A 10-year autopsy series

Background: Diabetic hepatosclerosis (DHS), recently described in liver biopsies in insulin-dependent diabetes mellitus, is characterized by dense perisinusoidal collagen. Aims: To evaluate prevalence of DHS in an autopsy series of diabetic patients. Methods: Liver slides and clinical charts from autopsied diabetics from 1997 to 2007 were reviewed. Exclusions were nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, cirrhosis of any cause, cardiac sclerosis and marked autolysis. Results: Of 976 autopsies in the 10-year period, 254 had DM, and 159 met criteria for inclusion. Nineteen cases (12%) met criteria of DHS. In contrast to the findings in the recently published series of 14 clinically indicated biopsies, the affected autopsy patients were more often men than women (14:5), were older (mean age 56.4 vs 45.8 years), and had less commonly recorded retinopathy and elevated alkaline phosphatase (16 and 32% vs 42 and 83%), respectively, but diabetic nephropathy was equally common (89 vs 83%). Compared with an age- and gender-matched group of autopsied diabetic patients without DHS, the DHS group had a significantly higher percentage of diabetic nephropathy (89 vs 47%, P < 0.05); no other statistically significant clinical differences were found between these two groups. Conclusions: DHS may represent a hepatic form of microvascular disease in DM; the prevalence of 12% in the autopsy series suggests it is not uncommon, but in the majority of the cases, it was clinically silent.