Etiopathogenesis and prognosis of centrilobular necrosis in hepatic grafts

Gómez, R; Colina, Francisco; Moreno, Enrique; García‐González, Ignacio; Loinaz, Carmelo; García, Ignacio; Musella, Mario; Garcia, H.; Lumbreras, Carlos; Maffettone, V.

doi:10.1016/s0168-8278(05)80325-3

Cited by 29 publications

(26 citation statements)

References 10 publications

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“…Previously described predisposing factors related to the development of centrilobular alterations were not identified in our study 12–14. We noted no differences in primary disease or age at time of transplant between recipients with and without centrilobular alterations.…”

Section: Discussioncontrasting

confidence: 67%

“…Although there are no previous studies directly comparing the prognosis of patients with and without centrilobular alterations during the first episode of acute rejection, several studies have demonstrated an association of a specific centrilobular alteration, centrilobular necrosis, with poor outcome 12–14. Unfortunately, not all of these studies have distinguished between centrilobular necrosis due to acute rejection and centrilobular necrosis associated with other lesions, such as ischemia due to chronic rejection and / or vascular thrombosis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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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-

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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“…12 14 Immunosuppressive therapy of acute rejection with CN appears to reverse the process in the majority of cases and may thus prevent the evolution towards chronic rejection and graft loss. [28][29][30] CN has also been associated with an increased incidence of chronic rejection. 10 12 28 31 In summary, CN (with sparing of the portal tracts) represents an infrequent histopathological feature of autoimmune hepatitis and may reflect an early stage of the disease associated with an acute clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Centrilobular necrosis in autoimmune hepatitis: a histological feature associated with acute clinical presentation

Hofer

Oesterreicher²,

Wrba³

et al. 2006

J Clin Pathol

129

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Aims:The characteristic histological feature of autoimmune hepatitis (AIH) is interface hepatitis with predominant portal lymphoplasmacytic necroinflammatory infiltration. Centrilobular necrosis (CN), reminiscent of toxic or circulatory liver injury, has been reported in AIH. The aim of this study was to assess the frequency of CN in patients with AIH and its correlation with laboratory and clinical data. Methods: Liver biopsies were obtained from 114 patients (90 women, 24 men, mean (SD) age 45.4 (19.4) years) with AIH and were evaluated under code by a single pathologist according to the modified Knodell score. Results: CN was found in 20 (17.5%) patients with virtually unaffected portal areas in four cases. Patients with AIH with CN had a higher total hepatic activity index (median (range) 11 (6 to 15) v 5 (2 to 10)) and presented less frequently with cirrhosis (10% v 38%). Patients with CN had a higher frequency of acute onset (87% v 32%), higher bilirubin (median (range) 12.0 (0.43 to 40.0) v 1.9 (0.36 to 46)) and higher ALT levels (median (range) 25.6 (2.7 to 63.9) v 7.2 (0.7 to 62.6)), than did patients with AIH without centrizonal injury. Conclusion: CN with sparing of the portal areas represents a rare histological pattern in AIH. CN is associated with an acute clinical presentation and might reflect an early lesion preceding portal involvement. Recognition of this particular histological appearance enables early diagnosis of AIH and a timely initiation of immunosuppressive therapy.A utoimmune hepatitis (AIH) is characterised by the presence of autoantibodies, hypergammaglobulinaemia, elevated serum transaminases, and the histological evidence of interface hepatitis with a predominantly portal lymphoplasmacytic necroinflammatory infiltrate.

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“…[3][4][5][6][7][8] A strong correlation between CLN and lobular inflammation has been described, and as well as the correlation between lobular inflammation and endothelialitis. 9 Our recent results, indicating that the lobular inflammation is an independent factor of its association with AR in biopsies with CLN, also support the notion that in the setting of CLN, lobular inflammation is indeed a manifestation of AR.…”

Section: Commentsmentioning

confidence: 99%

Can early liver biopsies predict long-term outcome of the graft?

Petrovic

2003

Liver Transpl

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Background: Chronic rejection (CR) in liver allografts show a rapid onset and progressive course, leading to graft failure within the first year after transplantation. Most cases are preceded by episodes of acute cellular rejection (AR), but histological features predictive for the transition toward CR are not well documented. Methods: We assessed the predictive value of centrilobular necrosis, central vein endothelialitis (CVE), central vein fibrosis, and lobular inflammation in the development of CR. One-week and one-month biopsy specimens of 12 patients with CR were compared with those of a control group consisting of 17 patients, who experienced AR without developing CR. The progress of the histological changes was further evaluated in follow-up biopsy specimens of the CR group taken at 2 months and beyond 3 months after transplantation. Results: Centrilobular necrosis, CVE, central vein fibrosis, and lobular inflammation were common features in both groups at 1 week. At 1 month, the incidence declined in the control group. The CR group showed an increased incidence and persistence of these features in the follow-up specimens. The incidence and median grade of severity of CVE was significantly higher in the CR group (p‫,40.0؍‬ and P<0.001). The severity of portal and lobular inflammation was also more pronounced in the CR group (P؉0.01 and 0.069). Conversely, in the control group the incidence of the lobular features decreased and the severity of CVE declined significantly (P‫.)30.0؍‬ Conclusion: The shift from a predominantly portal-based process toward lobular graft damage represents the early transition of AR to CR, for which a modification of immunosuppression might be necessary to prevent graft loss.

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Etiopathogenesis and prognosis of centrilobular necrosis in hepatic grafts

Cited by 29 publications

References 10 publications

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

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

Centrilobular necrosis in autoimmune hepatitis: a histological feature associated with acute clinical presentation

Can early liver biopsies predict long-term outcome of the graft?

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