Patterns of chronic liver disease in Kuwait with special reference to localisation of hepatitis B surface antigen.

Two hundred and fifty six consecutive liver biopsy specimens (without secondary malignancy) collected over five years were reviewed to characterise the pattern of liver diseases encountered in the Kuwait region. A relatively high proportion of chronic active hepatitis (19%) and cirrhosis (40%) was found. Localisation of HBsAg was carried out by the histochemical orcein method and the immunohistological peroxidase-antiperoxidase (PAP) procedure. The PAP technique was superior to orcein both in quality and quantity in addition to its specificity. Three immunohistological staining patterns were observed: diffuse pancytoplasmic , partial perinuclear, and peripheral cytoplasmic. The positivity rate of HBsAg in chronic hepatitis was 29% and 27%, in all cases of cirrhosis. The results of immunohistology and serology of HBsAg were compared in 52 patients in whom both tests were carried out; almost one third of chronic active liver diseases were positive by both methods. Our data clearly show the sensitivity of immunohistology and its value in detecting HBsAg, especially in retrospective studies where serology is not always available. Additionally, the data show that hepatitis B infection is often associated with the development of chronic liver disease in Kuwait.