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

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
  • 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


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