Acute hepatic allograft rejection: A comparison of patients with and without centrilobular alterations during first rejection episode

Abstract

The histologic diagnosis of acute hepatic allograft rejection is usually based upon the identification of characteristic portal tract features. In addition to these, centrilobular alterations such as central vein endothelialitis, zone 3 inflammation, and hepatocyte necrosis may also be seen during episodes of acute rejection. The purpose of this study was to identify any differences in the subsequent clinical course of patients with and without centrilobular alterations during their first biopsy-proven episode of acute rejection. Acute rejection was diagnosed at least once in 35 liver recipients who had undergone allograft biopsy. Of these, 15 (43%) had centrilobular alterations in their first posttransplant biopsy. These 15 patients developed ductopenia (60% vs. 30%) and subsequent epi-

Centrilobular changes in acute rejection: a severe acute rejection or already an early chronic rejection?

“…It has been well described previously that the incidence and severity of CA are higher in AR that ultimately evolves into CR [6,8] and the article by Lovell et al [3] confirms these observations. Based on our experience and published work we also suggest that AR with centrilobular predilection may present a special subset of AR or may even represent an unusual form of early CR [9].…”

“…In the context of AR, CA may be present with or without the presence of the portal features of AR. In the latter situation-which was the case in one of the patients in the study by Lovell et al [3]-the morphologic and clinical evidence of other potential causes for this lesion should be ruled out.…”

“…Although the importance of CA during the development of CR has been previously implicated [4 -6], this is the first study directly comparing the prognosis of AR with and without associated CA during the first episode of AR. Thus, the work by Lovell et al [3], allows to highlight again this finding as a pejorative prognostic factor and to question a shortcoming of the Banff classification for AR.…”

“…Some histological findings have been reported to have a predictive value for the graft outcome. A recent study by Lovell et al [3] draws attention to a particular form of AR that is associated with centrilobular alterations (CA). The CA was observed on the liver biopsies during the first AR episode in 43% of their patients with AR.…”

What is the long-term outcome of the liver allograft?

“…Late rejection with features of CP often presents with raised transaminase levels, contrasting with the cholestatic liver biochemistry that is more typically seen in early portal-based AR [33,34,41]. It tends to be less responsive to immunosuppression and is associated with an increased frequency of adverse outcomes -these include further episodes of acute rejection [36,42], progression to chronic rejection [32,33,39,[42][43][44][45], and the development of de novo autoimmune hepatitis [39,43]. In some cases, CP may lead to the development of centrilobular fibrosis [38,39].…”