Fine-Needle Aspiration Biopsy in the Monitoring of Liver Allografts.

Lautenschlager, Irmeli; Höckerstedt, Krister; Ahonen, J; Eklund, B; Isoniemi, Helena; Korsbäck, C; Pettersson, Eva; Salmela, K.; Tm, Scheinin; E, von Willebrand

doi:10.1097/00007890-198807000-00007

Cited by 48 publications

(26 citation statements)

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“…Conversely, acute rejection is associated with a large number of blasts and activated lymphocytes within the graft, and chronic rejection is associated with a large number of macrophages within the graft. 50 Although an occasional inclusion body can be seen within a bile duct epithelial cell nuclei, CMV hepatitis generally is not associated with bile duct destruction or loss.…”

Section: Differential Diagnosismentioning

confidence: 99%

Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection

1999

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Chronic hepatic allograft rejection is characterized by the histological findings of ductopenia and a decreased number of hepatic arteries in portal tracts in the presence of foam cell (obliterative) arteriopathy. Recent studies have extended the histological spectrum of chronic rejection to include the presence of biliary epithelial atrophy or pyknosis involving the majority of small ducts present in the liver biopsy specimen. Overall, the incidence of chronic rejection in adults appears to be decreasing and is currently approximately 4%. However, the incidence of chronic rejection in pediatric liver transplant recipients has been more stable and ranges from 8% to 12% in most studies. Clinical risk factors associated with chronic rejection include: underlying liver disease, HLA donor-recipient matching, positive lymphocytotoxic cross-match, cytomegalovirus infection, recipient age, donor-recipient ethnic origin, male donor into female recipient, number of acute rejection episodes, histological severity of acute rejection episodes, low cyclosporine trough levels, and retransplantation for chronic rejection. Chronic rejection, once diagnosed, frequently leads to graft failure; however, a number of reports indicated 20% to 30% of the patients with this diagnosis may respond to additional immunosuppressive therapy or even resolve spontaneously receiving baseline immunosuppression. Newer immunosuppressive agents, such as tacrolimus and mycophenolate, may successfully reverse chronic rejection, particularly when it is diagnosed in its early histological stages.

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Section: Differential Diagnosismentioning

confidence: 99%

Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection

1999

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“…The appearance of IL-2-receptor expression in the graft has also been shown to correlate with acute rejection of the rat liver [18]. The upregulation of class I1 and ICAM-1, recognized in human and rat allografts [l, 14,16,17,191, followed the overall course of immune activation in the FNAB.…”

Section: Discussionmentioning

confidence: 99%

“…In the rat liver, mononuclear cell infiltration of portal areas is also the major histological finding in allograft rejection, together with parenchymal necrosis and endothelialitis, but the bile ducts are not consistently affected [S, 151. Fine needle aspiration biopsy (FNAB), originally developed at our clinic in Helsinki for the monitoring of kidney allografts [3,13], is also used routinely in clinical liver transplantation and has been reported by several groups [2,4,9-11, 14, 17, 201. The hallmark of acute liver allograft rejection, demonstrated by aspiration cytology, is the appearance of lymphocytosis and lymphoid blasts in the graft.…”

Section: Introductionmentioning

confidence: 99%

A rat model of monitoring liver allograft rejection

et al. 1997

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Rat models are often used to study liver allograft rejection. We have established a model for rat liver allograft rejection, monitored by fine needle aspiration biopsy (FNAB), in the strain combination PVG-to-BN with a mean survival time of 37 k 20 days. In this model, we observed acute rejection with an intense peak of lymphoid blasts and lymphocyte-dominated inflammation in the FNAB [9.1 f 3.0 corrected increment units (CIU)], and an eventual increase in macrophages (up to 4.2 f 4.4 CIU), together with fibrosis and parenchymal necrosis in the graft. Markers of immune activation, such as an increase in IL-2-receptor (from 1 YO f 2 YO to 21 % f 13 YO) and class I1 (from 20 YO & 9 Yo to 43 % f 13 Yo) expressing lymphoid cells and induction of ICAM-1 in the graft, were consistent with the overall cellular response. The FNAB correlated well with parallel graft histology. In this rat model, the atraumatic monitoring makes a close follow-up possible without having to sacrifice the experimental animals. This saves work, animals, and costs in the study of liver rejection.

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“…Nine patients received ABO incompatible grafts. Biliary atresia (n = 21) tyrosinemia (9), and hepatic tumor (8) were the main indications for transplantation. Nine re-transplantations were performed.…”

Section: Patients and Medicationmentioning

confidence: 99%

The use of fine-needle aspiration biopsy in detection of acute rejection in children after liver transplantation

Their¹,

Lautenschlager²,

Willebrand³

et al. 2002

Transplant Int

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Diagnosis of acute rejection after liver transplantation is based mainly on clinical signs and the liver core biopsy findings. In this study we retrospectively analyzed our data on the routine use of fineneedle aspiration biopsy (FNAB) after 63 pediatric liver transplantations. A total of 824 FNABs was taken during the postoperative hospitalization, with a mean of 13 biopsies per patient. Forty-nine acute rejection episodes were diagnosed and treated after 39 transplantations (62%). The FNAB analysis detected rejections often before clinical signs. At the time of rejection diagnosis, fever was present in 38% of the patients, and serum bilirubin and alanine aminotransferase were elevated in only 19% and

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Fine-Needle Aspiration Biopsy in the Monitoring of Liver Allografts.

Cited by 48 publications

References 0 publications

Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection

Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection

A rat model of monitoring liver allograft rejection

The use of fine-needle aspiration biopsy in detection of acute rejection in children after liver transplantation

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