The aim of the present study is to examine the etiological origins of cryptogenic cirrhosis in patients who were followed up with the disease

OBJECTIVE: The aim of the present study is to examine the etiological origins of cryptogenic cirrhosis in patients who were followed up with the disease. METHOD: Among 2400 cirrhosis patients who applied to Inonu University Turgut Ozal Medical Center Hepatology outpatient clinic between 2010-2018, the post-transplant pathology results of 324 patients diagnosed with cryptogenic cirrhosis of unspecified etiology were examined. The FIB-4 and APRI score were calculated to determine the degree of fibrosis in all patients prior transplantation. Patients with pathological NASH were investigated for BMI and diabetes, and the NAFLD score was calculated. All patients with cirrhosis were examined for their conversion to HCC by imaging, laboratory testing and pathological examination. At the same time, the presence of ascites was examined by imaging methods. CHILD and MELD scores of patients were calculated prior transplantation. Comparison was made between the blood groups of patients. RESULTS: A pathological examination of patients, revealed that, 22 (6,8%) of the patients had results compatible with veno-occlusive disease, 80 (24,7%) had results compatible with hepatosteatosis (NASH, NAFLD), 25 (7,7%) with hepatocellular carcinoma, 1 (0,3 %) with alpha-1 antitrypsin deficiency, 4 (1,2 %) with hemochromatosis, 7 (2,1 %) with HBV hepatitis, 2 (0,6 %) with hemophagocytic syndrome, 17 (5,2 %) with biliary pathology-related cirrhosis (PSK, PBS, etc.), 2 (0,9 %) with ischemic hepatitis, 14 (4,3 %) with autoimmune hepatitis, 10 (3 %) with Wilson, 1 (0,3 %) with glycogen storage disease, 2 (0,6 %) with amyloidosis, 2 (0,6 %) with HCV hepatitis and the number of patients with undetermşnant etiology was 135 (41,7 %). The mean age of the patients was 47,5 (± 14,6). While ascites was not observed in 92 (28,5 %) patients, ascites was detected in 232 (71,5 %) patients. While HCC was detected in 57 (17,3 %) patients, HCC was not observed in 267 (82,7 %) patients. DM or insulin resistance was observed in 53 (66,15 %) of our patients with NASH. No DM or insulin resistance was detected in 27 (33,85 %) patients. When BMI of 80 patients diagnosed with NASH was examined, the number of patients with BMI between 25-30 was 26 (32,5 %), the number of those with BMI> 30 was 32 (40 %), and the remaining 22 patients (27,5 %) had BMI below 25. In patients with cryptogenic cirrhosis, the mean CHILD score before transplantation was 12,1 (± 1,4), while the MELD score was calculated as an average of 28,5 (± 5,3). When the blood groups of the patients are examined, it has been identified that the number of those with 0 RH + is 102 (31,1 %), the number of those with A Rh (+) is 104 (32 %), the number of those with B Rh (+) is 50 (15,4 %), the number of those with AB Rh (+) is 24 (7,4 %), the number of those with A Rh (-) is 24 (7,4 %), the number of those with 0 Rh (-) is 16 (4,9 %) the number of those with AB Rh (-) is 2 (0,6 %) and the number of those who are B Rh (-) is 3 (0,9 %). CONCLUSİON: When the pathological examinations of the patients who were followed up as cryptogenic cirrhosis were performed, the presence of many diseases was determined in the etiology. Especially non alcoholic fatty liver disease and non alcoholic steatohepatitis play an important role in etiology. The presence of NASH/NAFLD should be investigated in patients with metabolic syndrome either by non-invasive tests or by biopsy. The pathological detection of HBV hepatitis in patients with negative serology, should awaken suspicion even in the abscence of HBV DNA and HBsAg positivity. Some of the patients were pathologically compatible with veno occlusive disease, although they were not monitored on imaging. Therefore, in patients whose etiology is not clarified, it should be one of the diseases considered in the foreground. It should be borne in mind that blood groups play a role in the risk of converting to HCC. Key words: Cryptogenic cirrhosis, liver transplantation, non alcoholic fatty liver