Early histological predictors of chronic liver allograft rejection
Index
Annette Gouw
Dept. of Pathology, University Hospital, Groningen, the Netherlands
According to the definition of the international working party on the terminology of acute rejection in 1995, chronic rejection (CR) in liver allografts is characterised by two main histologic features: obliterative vasculopathy and loss of small bile ducts (1). These hallmarks are readily recognized in the failed grafts after transplantectomy, but not in the graft biopsies during the development of CR. Due to its presence mainly in medium sized branches of the hepatic artery, obliterative arteriopathy is an unusual finding in graft biopsies. Damage and/or loss of small bile ducts follows a variable course between CR patients. It may present as an early finding but can also be found in minor degrees or quantities even in the failed grafts. Therefore, early recognition of CR could be difficult. In graft biopsies preceding CR we have observed two other histologic features that were present before ductopenia developed: 1. perivenular hepatocyte drop out and 2. in a small number of patients, a persistent, mostly mild mononuclear lobular inflammation. Early perivenular hepatocyte drop out was present in the majority of CR patients. The incidence, severity and differential diagnosis of these two features will be discussed to assess the possible role of these histologic changes as early predictors of CR in liver grafts.
1. International Working Party, terminology of hepatic allograft rejection.
Hepatology 1995; 22:648-654
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