Current views on rejection pathology in liver transplantation

Neil, Desley; Hübscher, Stefan G.

doi:10.1111/j.1432-2277.2010.01143.x

Cited by 133 publications

(102 citation statements)

References 95 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In presence of active CMV infection, the immunosuppression should be reduced along with instituting specific therapy such as Ganciclovir/Valganciclovir. 74,75 Rejection Acute cellular rejection (ACR) presents with a histological triad of portal tract infiltrates, bile duct injury, and venous endothelialitis, 76 typically biopsy proven acute rejection is treated with pulse intravenous steroid boluses. In many cases, mild to moderated rejection can be treated with increasing the levels of CNI alone.…”

Section: Immunosuppression and CMV Infectionmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

show abstract

Section: Immunosuppression and CMV Infectionmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…The prevalence of IPTH is difficult to determine and varies considerably among transplant centres. The first reason is the lack of proper definition [4] . Indeed, IPTH is most common in centres that perform protocol LBs and in those that traditionally run patients on low levels of immunosuppression [4,8] .…”

Section: Discussionmentioning

confidence: 99%

“…The first reason is the lack of proper definition [4] . Indeed, IPTH is most common in centres that perform protocol LBs and in those that traditionally run patients on low levels of immunosuppression [4,8] . Overall, prevalence increases over time from 10% to 50% of protocol LB performed > 1 year posttransplant in adults, and in up to 60% of children at 10 years post-LT [2] .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Idiopathic Post Liver-Transplant Hepatitis Remains Obscure with Respect to Its Etiology and Relationship with Immunosuppressiona

Sebagh¹,

Coilly²,

Ha飉-Boukobzsa³

et al. 2015

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

AIM: Idiopathic post-liver transplant hepatitis (IPTH) can lead to late graft fibrosis. The treatment for IPTH is not clearly delineated. We aimed to approach its pathophysiology and predictive factors for fibrosis progression (FP). METHODS: Patients whose IPTH was diagnosed in 2006 and had undergone at least one subsequent liver biopsy (LB) were included.The index LBs were reviewed and correlated with clinical, laboratory, C4d immunostaining retrospectively performed, and histological data on the most recent LBs. RESULTS: Among the 299 post-transplant LBs, 37 presented IPTH. The index LBs mostly displayed mild fibrosis (65%) and activity (67.5%), and non-significant C4d immunostaining (i.e., weak, focal and/or portal stroma staining, 21.6%). Liver tests were normal in 46% of patients. Virological markers including Hepatitis E were negative. Antinuclear auto-antibodies were present concurrently in four patients and appeared later in two patients, together with features of autoimmune hepatitis (AIH) in one. Isolated AIH features appeared later in one patient. One patient displayed AIH features on the index LB, with negative autoantibodies and elevated serum IgG. Fibrosis was stable, increased or decreased in 23, 11, and three patients, respectively. FP was less frequent in tacrolimus-treated patients (p = 0.022), more frequent in cyclosporine-(p = 0.035) and MMF-treated patients (p = 0.023), and not influenced by steroid-based treatment or increased overall immunosuppression or steroids. Under multivariate analysis, MMF remained an independent predictor of FP (p = 0.048). CONCLUSION: The physiopathology of IPTH remained unclear. Increasing steroid doses or overall immunosuppression did not prevent FP. The potential impact of MMF on FP will require prospective studies.

show abstract

“…84,95,97 Therefore, C4d staining should be interpreted with caution and has no particular significance without the correct clinical context and congruent histopathologic changes in the biopsy. 83,87,93,98 With positive staining, the possibility of ABMR can be raised but not specifically diagnosed.…”

Section: Livermentioning

confidence: 99%

Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

Troxell¹,

Lanciault

2016

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

Context.-Immunohistochemical analysis of tissue biopsy specimens is a crucial tool in diagnosis of both rejection and infection in patients with solid organ transplants. In the past 15 years, the concept of antibody-mediated rejection has been refined, and diagnostic criteria have been codified in renal, heart, pancreas, and lung allografts (with studies ongoing in liver, small intestine, and composite grafts), all of which include immunoanalysis for the complement split product C4d.Objectives.-To review the general concepts of C4d biology and immunoanalysis, followed by organ-allograftspecific data, and interpretative nuances for kidney, pancreas, and heart, with discussion of early literature for lung and liver biopsies. Additionally, practical applications and limitations of immunostains for infectious organisms (Polyomavirus, Adenoviridae [adenovirus], and the herpes virus family, including Herpes simplex virus, Cytomegalovirus, Human herpes virus 8, and Epstein-Barr virus) are reviewed in the context of transplant recipients.Data Sources.-Our experience and published primary and review literature.Conclusions.-Immunohistochemistry continues to have an important role in transplant pathology, most notably C4d staining in assessment of antibody-mediated rejection and assessment of viral pathogens in tissue. In all facets of transplant pathology, correlation of morphology with special studies and clinical data is critical, as is close communication with the transplant team.

show abstract

Current views on rejection pathology in liver transplantation

Cited by 133 publications

References 95 publications

Current Status of Immunosuppression in Liver Transplantation

Current Status of Immunosuppression in Liver Transplantation

Idiopathic Post Liver-Transplant Hepatitis Remains Obscure with Respect to Its Etiology and Relationship with Immunosuppressiona

Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

Contact Info

Product

Resources

About