Reliability of acidophil bodies as a marker of recurrent Hepatitis C infection after orthotopic liver transplantation
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R Saxena, JM Crawford, VJ Navarro, AL Friedman, and ME Robert
Yale University School Of Medicine, New Haven, CT
Background. End stage liver disease due to chronic hepatitis C infection is rapidly becoming the most common reason for orthotopic liver transplantation (OLT). A growing problem in clinical management is the recurrence of hepatitis C infection and clinical disease in livers transplanted into hepatitis C positive patients. When hepatitis C recurs months after transplantation, the pathologic diagnosis is straightforward, as other causes of portal inflammation, such as acute rejection are usually confined to the early post-transplant period. However, the distinction between acute rejection and early recurrent hepatitis C infection (RHCV) is often difficult. Acidophil bodies (AB) and lobular hepatitis are used to suggest a diagnosis of RHCV over rejection, however, studies have not established the reliability of this practice. Design: Quantification of AB was performed on liver biopsies in OLT patients with unequivocal RHCV (n=10, confirmed by serial biopsies and appropriate serum enzyme fluctuations), non-hepatitis C OLT patients with uncomplicated rejection episodes (n=10, confirmed by clinical response to immunosuppression) and non-transplant patients with chronic hepatitis C infection (n=10). Biopsies within the first two weeks of transplantation were excluded to avoid preservation injury. In the RHCV group, serial biopsies were reviewed by two pathologists and the index biopsy representing the first histologic evidence of RHCV was identified. H&E stained slides were randomized and tissue fragments 1cm in length and of variable width (0.4-0.13cm) were examined at 200x magnification in a blinded fashion by two pathologists in order to quantify the number of AB/cm2. Lobular chronic inflammation was graded on a 0-3+ scale. Results. Liver biopsies of the first episode of RHCV infection exhibited 606 +101 AB/cm2 (+SEM, range 200-1390). These counts were significantly greater than (p<0.01 by ANOVA) the 241+53 AB/cm2 (range 80-514) for acute rejection and 194+21 AB/cm2 (range 100-333) for non-OLT HCV infection. Serial biopsies in RHCV patients revealed no consistent pattern in the number of AB over time. No difference in lobular inflammation between index RHCV and rejection biopsies was detected. Conclusions: Although there is overlap, on average there are twice as many AB in the initial stage of RHCV infection when compared with acute rejection. Lobular inflammation was not a reliable indicator of the onset of RHCV.
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