Transitional features from acute to chronic liver allograft rejection
Index
Annette Gouw
Dept. of Pathology, University Hospital, Groningen, the Netherlands
The development of chronic liver graft rejection (CR) may be promoted by episodes of acute rejection (AR). CR has been reported to be associated with severe AR or steroid resistant AR. Therefore, in these conditions the development CR could be anticipated. However, the histologic features of AR and its grading system (1) do not include features that allow the recognition of a transition from AR to CR. In the Banff grading criteria for AR, perivenular hepatocyte necrosis is included as a feature of severe AR as it is correlated with moderate to severe inflammation. In graft biopsies preceding CR we have observed perivenular hepatocyte drop out in the presence of only mild portal inflammation. Based on the inflammatory activity this rejection episode would only be graded as mild. As in some patients the perivenular drop out appeared to be progressive towards the development of CR, we considered the perivenular changes as a possible transitional feature to CR. A second feature is the disproportionate damage of bile duct epithelial cells during a mild AR episode preceding the development of CR. In a background of mild portal inflammation bile duct epithelial cells appeared severely damaged. The incidence and course of these two features of AR will be discussed to establish the possible transition from an AR episode to CR.
1. Demetris AJ, Batts KP, Dhillon AP et al. Banff schema for grading liver allograft rejection: An international consensus document.
Hepatology 1997; 25:658-663.
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