Chronic Liver Rejection
Histologic Features of Early and Late Chronic Liver Allograft Rejection
Structure

Early CR

Late CR

Small bile ducts

(<60 um)

Degenerative changes involving a majority of ducts (eosinophilic transformation of the cytoplasm; increased N:C ratio; nuclear hyperchromasia; uneven nuclear spacing; ducts only partially lined by biliary epithelial cells)


Bile duct loss <50% of portal tracts

Degenerative changes in remaining bile ducts


Loss in >=50% of portal tracts

Terminal hepatic venules and zone 3 hepatocytes

Intimal/lumenal inflammation


Lytic zone 3 necrosis and inflammation 


Mild perivenular fibrosis

Focal obliteration


Variable inflammation


Severe (bridging) fibrosis

Portal tract hepatic arterioles  Occasional loss involving <25% of portal tracts Loss involving >25% of portal tracts
Other So-called "transition" hepatitis with spotty necrosis of hepatocytes Sinusoidal foam cell accumulation; marked cholestasis
Large perihilar hepatic artery branches  Intimal inflammation, focal foam cell deposition without lumenal compromise

Lumenal narrowing by subintimal foam cells


Fibrointimal proliferation

Large perihilar bile ducts  Inflammation damage and focal foam cell deposition Mural fibrosis
 
Reference 
  • Demetris A, Adams D, Bellamy C, Blakolmer K, Clouston A, Dhillon AP, Fung J, Gouw A, Gustafsson B, Haga H, Harrison D, Hart J, Hubscher S, Jaffe R, Khettry U, Lassman C, Lewin K, Martinez O, Nakazawa Y, Neil D, Pappo O, Parizhskaya M, Randhawa P, Rasoul-Rockenschaub S, Reinholt F, Reynes M, Robert M, Tsamandas A, Wanless I, Wiesner R, Wernerson A, Wrba F, Wyatt J, Yamabe H. : Update of the International Banff Schema for Liver Allograft Rejection: Working Recommendations for the Histopathologic Staging and Reporting of Chronic Rejection Hepatology 31(3):792-799, 2000
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Last Modified: Thu Jun 18 10:14:08 EDT 2009