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    Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies
    (2021) Hatipoğlu, Sinan; Dirican, Abuzer; Ateş, Mustafa; Çevik, Muhammer Özgür; Yumrutaş, Önder; Şık, M. Ali; Yılmaz, Sezai
    Objective: End-stage liver disease (ESLD) is a devastating condition, which leads to liver transplantation (LT). There are various proposed predisposing factors for ESLD. A significant proportion of ESLDs is of undetectable (cryptogenic) origin. Accumulation of heavy metals is a proposed but not thoroughly researched predisposing factor for ESLD. In this study, we measured the concentration of accumulated heavy metals in the explanted liver tissue of ESLD patients. Apart from various accompanying etiologies, such as rare hereditary diseases, infections, and tumors were also evaluated. Method: This prospective study aimed to evaluate the concentrations of heavy metals in the explanted liver of consecutive patients with ESLD and different etiologies who underwent elective and/or emergency LT. Bioaccumulation of nine heavy metals (Hg, As, Zn, Cr, Pb, Cu, Ni, Mg, and Fe) was evaluated by atomic absorption spectrophotometer in the explanted liver tissue of ESLD patients. Also, histopathologies of explanted livers and etiologies of patients were evaluated using data from histopathological techniques, medical records, or genetic counseling processes. Results: The male/female ratio was 33: 15. The results of our study showed no statistical significance in terms of total heavy metal levels in the explanted livers (p > 0.05), including patients with cryptogenic etiology. However, four patients with Wilson’s disease had copper levels of 250 uq/g dried liver tissue. Histopathological examinations of explanted livers revealed that four (8%) patients had Wilson’s disease, one (2%) patient had tyrosinemia, 15 (31%) patients had unknown/undetectable (cryptogenic) etiology, 24 patients had viral infections (20 had hepatitis B virus infection, one had hepatitis C virus infection, three had multiple viral infections at once), one patient had a metastatic tumor, one patient had an unidentified autoimmune disease, and one patient had polycystic liver disease. Conclusion: Accumulated total heavy metal levels in explanted livers of ESLD patients do not appear to be a differential diagnosis tool, except the copper levels for Wilson’s disease. More research is needed to further elucidate the different roles of heavy metal concentrations in both normal and disease states of heavy metals in the liver.