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All complications were managed conservatively, and required no surgical intervention or blood transfusions. Histological evaluation was done by two pathologists (SS and AC). Liver tissue was adequate for histological diagnosis in 69 (97.1%) patients. The mean number of cores was three (range: 2�C5); the mean core tissue length was 1.9?cm (range: 1.7�C2.2?cm), http://www.selleck.cn/products/BIBW2992.html and on average, five complete portal tracts (range: 0�C10) were identified. A presumptive etiological diagnosis was established clinically before TJLB in all cases. Histological diagnoses based on TJLB findings confirmed this clinical diagnosis in 56 (81.2%) of 69 patients. In four of the remaining 13 patients with clinical diagnosis of ALF other than acetaminophen toxicity or viral hepatitis (A and B); an unexpected diagnosis was made histologically. These included giant cell hepatitis in one, Reye��s syndrome in one, mitochondrial disorder in one, and malignant http://www.selleckchem.com/products/ly2157299.html hemangioendothelioma in one. In other three patients with a presumptive clinical diagnosis of cryptogenic ALF, a diagnosis of autoimmune hepatic failure; and in one patient with a clinical diagnosis of acetaminophen induced ALF, a diagnosis of idiosyncratic drug reaction was established histologically. Clinically, the coexistence of chronic liver disease was suspected in two cases; however, histological analyses demonstrated associated fibrosis in five patients. Based on the clinical and biochemical findings, and existing prognostic scores, 50 (70.4%) patients were listed for LT and 21 patients were continued on supportive management. Forty-five (90%) patients were listed as United Network for Organ Sharing (UNOS) status 1 candidates while five patients were listed per http://www.selleckchem.com/products/z-vad-fmk.html their respective MELD scores because of associated chronic liver disease on TJLB. Nine of 50 patients died while waiting for transplant. Tables?2 and 3 illustrates the outcome based on diagnoses and percentage of hepatocyte necrosis respectively. The diagnoses among non-survivors were acetaminophen overdose in two, cryptogenic in four, autoimmune in one, idiosyncratic drug reaction (sulpha drug) in one, and mitochondrial disease in one. Seven of them demonstrated hepatocellular necrosis >90% on TJLB and four had histological findings suggestive of coexisting chronic liver disease. The median time from listing to adverse outcome was 3.5?days (range: 1�C31?days). While on waiting list, ten patients showed improvement with supportive treatment and were taken off from the list subsequently. Among survivors, the biopsy findings demonstrated varying degree of micro- and macro-vesicular steatosis with associated steatohepatitis in six patients, and hepatocellular necrosis ranged from no necrosis in two, necrosis