Include: Grafts which have failed from chronic rejection, as defined by >50% of portal tracts without bile ducts and / or foam cell arteriopathy, and the explanted graft has been examined (at either autopsy or retransplant). We must have the explant otherwise we will miss cases which are purely vascular.
In these patients all biopsies are to be scored as per the scoring sheet, the biochemistry (AST, Alkaline Phosphatase &/or(GT, bilirubin) at the time of biopsy is to be documented together with any treatment (antirejection) given. If antirejection treatment was given before the biopsy this should be noted together with the biochemistry prior to treatment. The time from transplantation to the individual biopsies and graft failure (taken as time to retransplantation or patient death) should be noted.
The t0 biopsy is being included
to try to distinguish centrilobular changes possibly associated
with obliterative arteriopathy from preservation injury. Also
it can be used as a baseline for counting arteries and bile ducts
in needle biopsies.
Patients Name:
Date of Biopsy:
Biopsy Number:
PORTAL TRACTS | ||
bile duct numbers | ||
artery numbers | ||
PARENCHYMA | ||
ballooning | ||
necrosis | ||
microvesicular fat | ||
pmns | ||
cholestasis |
Patients Name:
Date of Biopsy:
Biopsy Number:
SCORE | ||
INFLAMMATION | ||
INTERFACE HEPATITIS | ||
BILE DUCTS : Inflammation | ||
BILE DUCTS: "dysplastic" ducts | ||
BILE DUCTS: Number | ||
PORTAL V ENDOTHELIALITIS | ||
ARTERIES: Number | ||
ARTERIES: Inflammation | ||
ARTERIES: Foam cells | ||
ARTERIES: Fibrosis | ||
PORTAL TRACT FIBROSIS | ||
PORTAL TRACT FOAM CELLS | ||
CHOLESTASIS: Severity | ||
CHOLESTASIS: Location | ||
PERIVENULAR: Inflammation | ||
PERIVENULAR: Ballooning | ||
PERIVENULAR: Necrosis - Pattern | ||
PERIVENULAR: Necrosis - Severity | ||
PERIVENULAR: Haemorrhage/congestion | ||
HEPATIC VEIN ENDOTHELIALITIS | ||
FOAM CELLS | ||
FIBROSIS |
ONLY APPLICABLE FOR EXPLANTS | ||
ARTERIES: Foam cells | ||
ARTERIES: Pattern of foam cells | ||
ARTERIES: Inflammation | ||
ARTERIES: Smooth muscle proliferative lesion | ||
ARTERIES: Intimal fibrosis | ||
LARGE BILE DUCT INFLAMMATION |
SCORE RANGE | |
PORTAL TRACTS | |
bile duct numbers | x1/y * |
artery numbers | x2/y * |
PARENCHYMA | |
ballooning | Y/N |
necrosis | 1=Small foci 2=confluent necrosis 3=bridging necrosis |
microvesicular fat | 0=nil 1=mild 2=moderate 3=severe |
pmns | 0=nil 1=few 2=moderate 3=numerous |
cholestasis | 0=nil 1=mild 2=moderate 3=severe |
* EQUATION
x1 = number of bile ducts
x2 = number of arteries
y = total number of portal tracts
INFLAMMATION | 0=nil 1=mild 2=moderate 3=severe |
INTERFACE HEPATITIS | 0=nil 1=mild 2=moderate 3=severe |
BILE DUCTS Inflammation | 0=nil 1=mild 2=moderate 3=severe |
BILE DUCTS "dysplastic" ducts | Y/N |
BILE DUCTS number | x1/y * |
PORTAL V ENDOTHELIALITIS | 0=nil 1=mild 2=moderate 3=severe |
ARTERIES: Number | x2/y * |
ARTERIES: Inflammation | 0=nil 1=mild 2=moderate 3=severe |
ARTERIES: Foam cell | Y/N |
ARTERIES: Initmal Fibrosis | Y/N |
PORTAL TRACT FIBROSIS | Y/N |
PORTAL TRACT FOAM CELLS | Y/N |
CHOLESTASIS: Severity | 0=nil 1=mild 2=moderate 3=severe |
CHOLESTASIS: Location | 0=none 1=perivenular 2=other |
PERIVENULAR: Inflammation | 0=nil 1=mild 2=moderate 3=severe |
PERIVENULAR: Ballooning | Y/N |
PERIVENULAR: Necrosis - Pattern | 1=lytic 2=coagulative |
PERIVENULAR: Necrosis - Severity | 0=none 1=Small foci 2=confluent necrosis 3=bridging necrosis |
PERIVENULAR: Haemorrhage/Congestion | Y/N |
HEPATIC VEIN ENDOTHELIALITIS | 0=nil 1=mild 2=moderate 3=severe |
FOAM CELLS | Y/N |
FIBROSIS | 0=none 1=Zonal 2=bridging 3=nodular/cirrhosis |
ARTERIES: Foam cells | 0=none affected 1=some affected 2=most affected |
ARTERIES: Pattern of foam cells | 1=intimal 2=intima+media 3=intima+media+adventitia |
ARTERIES: Inflammation | Y/N |
ARTERIES: Smooth muscle proliferative lesion | Y/N |
ARTERIES: Intimal fibrosis | Y/N |
LARGE BILE DUCT INFLAMMATION | 0=nil 1=mild 2=moderate 3=severe |
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