Chronic Liver Rejection
Histologic Features of Early and Late Chronic Liver Allograft Rejection
and Suggested Fibrosis Scoring
Structure

Early CR

Late CR


Small bile ducts

(<60 um)

Senescence-related 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


Perivenular mononuclear inflammation


Lytic zone 3 necrosis and inflammation 


Mild perivenular fibrosis (See below)

Focal obliteration


Variable inflammation


Moderate to severe (bridging) fibrosis (See below)

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 luminal compromise

Lumenal narrowing by subintimal foam cells


Fibrointimal hyperplasia

Large perihilar bile ducts 

Inflammation damage and focal foam cell deposition

Mural fibrosis

Suggested Fibrosis Scoring 

Score as 0 to 3 for the following:
Portal/periportal: 0 (none) to 3 (portal-portal or portal-central bridging)
Subsinusoidal: 0 (none) to 3 (marked and diffuse)
Perivenular: 0 (none) to 3 (central-central or central-portal bridging)

Final score is the sum of the scores, ranging from 0-9
Recording the individual scores is also desirable.

 
References 
  • Demetris AJ et al. 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of antibody-mediated rejection. Am J Transplant 2016;16:2816-28335
  • Venturi C et al. Novel histologic scoring system for long-term allograft fibrosis after liver transplantation in children. Am J Transplant 2012; 12:2986-2996
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Last Modified: Fri Jun 15 15:26:51 EDT 2018