Histological Features Predictive of Recurrence of Primary Biliary Cirrhosis After Liver Transplantation

Sebagh, Mylène; Farges, Olivier; Dubel, Laurence; Samuel, Didier; Bismuth, H; Reynès, M

doi:10.1097/00007890-199805270-00008

Cited by 64 publications

(39 citation statements)

References 17 publications

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“…Plasma cell-rich periportal hepatitis may be an early marker predictive of later PBC recurrence. 82 Nonspecific lobular findings include mild spotty hepatocyte apoptosis, slight sinusoidal lymphocytosis, mild nodular regenerative hyperplasia, and Kupffer cell granulomas.…”

Section: Recurrent Diseases and New-onset Diseasesmentioning

confidence: 99%

Liver biopsy interpretation for causes of late liver allograft dysfunction

2006

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Evaluation of needle biopsies and extensive clinicopathological correlation play an important role in the determination of liver allograft dysfunction occurring more than 1 year after transplantation. Interpretation of these biopsies can be quite difficult because of the high incidence of recurrent diseases that show histopathological, clinical, and serological features that overlap with each other and with rejection. Also, more than one insult can contribute to allograft injury. In an attempt to enable centers to compare and pool results, improve therapy, and better understand pathophysiological disease mechanisms, the Banff Working Group on Liver Allograft Pathology herein proposes a set of consensus criteria for the most common and problematic causes of late liver allograft dysfunction, including late-onset acute and chronic rejection, recurrent and new-onset viral and autoimmune hepatitis, biliary strictures, and recurrent primary biliary cirrhosis and primary sclerosing cholangitis. A discussion of differential diagnosis is also presented. (HEPATOLOGY 2006;44:489-501.)

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Section: Recurrent Diseases and New-onset Diseasesmentioning

confidence: 99%

Liver biopsy interpretation for causes of late liver allograft dysfunction

2006

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“…For example, Sebagh 13 described the histologic features in the allograft of 69 patients grafted for PBC and 53 patients grafted for alcoholic and metabolic liver disease; all had been followed for over 1 year. Histologic features of PBC (such as nonsuppurative, destructive cholangitis; mixed portal cell infiltrate; and ductopenia) were present in 6 of the 69 patients grafted for PBC and none of the metabolic/alcohol group.…”

Section: Histologic Evidence For Recurrence Of Pbc In the Allograftmentioning

confidence: 99%

“…Some centers (including our own in Birmingham) that have reported in preliminary studies that there was no evidence for recurrent PBC have later reached different conclusions. 11,13,20 Thus, Dubel et al 5 reported in 1995 on the liver histology of 16 patients transplanted for PBC and followed for at least 4 years; 6 patients developed histologic features of chronic active hepatitis (related to HCV infection in 5 and HBV infection in 1) and 1 patient had mild steatosis 2 years after transplantation; the other 9 patients had either no, or else a mild, transient portal tract infiltrate, and none had features of recurrent PBC. All patients were maintained on triple immunosuppression with corticosteroids, azathioprine, and ciclosporin.…”

Section: Why Do All Reports Not Agree On Recurrence?mentioning

confidence: 99%

Recurrent primary biliary cirrhosis

Neuberger

2003

Liver Transplantation

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T he rate of primary biliary cirrhosis (PBC) recurrence is uncertain and the different rates described in the literature reflect in part the diagnostic difficulties and in part the use of protocol biopsies, because histologic evidence of PBC recurrence is not always associated with the development of cholestatic liver tests.Recurrence of PBC appears to have little impact on long-term graft function and survival, but, with lengthening follow-up, this may become a greater problem. Whether ursodeoxycholic acid has any effect on the natural history of recurrent PBC has not been assessed.Recurrence of PBC may give some insight to the pathogenesis: The more rapid progression in the allograft compared with in the native liver, the early appearance in the graft of the aberrant distribution of E2 (the main target of the antimitochondrial antigen) and the increased rate of recurrence in those with tacrolimus as the main immunosuppressive agent is compatible with an infective trigger but clearly does not exclude other causes.Although there was some initial controversy, most centers now have reported recurrence of PBC: Recurrence is of importance not only for the patient and the clinician, but also gives potential insight into the etiology of the disease. The etiology of PBC remains uncertain, and the documentation of recurrence and understanding of risk factors may give useful tips concerning the pathophysiology of the condition and so lead to effective treatments.

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“…5 It is now well established that PBC may recur in the allograft in some patients. [6][7][8] In this study, we have reviewed our clinical experience with 400 consecutive PBC patients who underwent a total of 416 liver transplantations. The aims were to determinate the actuarial patient and graft survival, reasons for graft loss and death, to determine how referral and transplant patterns have changed with time and to determine the incidence of recurrent disease.…”

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confidence: 99%

Transplantation for Primary Biliary Cirrhosis: Retrospective Analysis of 400 Patients in A Single Center

et al. 2001

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Orthotopic liver transplantation (OLT) is an effective treatment for patients with advanced primary biliary cirrhosis (PBC). We have conducted a retrospective analysis of 400 consecutive patients transplanted for PBC between 1983 and 1999. Mean follow-up was 56 months. The proportion of patients grafted for PBC fell progressively, from 35% in 1990 (n ‫؍‬ 80) to 21% in 1999 (n ‫؍‬ 111); comparison of patients grafted in the 2 decades showed that the median age increased from 53 to 56 years and the median serum bilirubin at transplantation fell from 270 mol/L to 132 mol/L. The overall actuarial patient and graft survival at 1, 5, and 10 years is 83%, 78%, and 67% and 82%, 75%, and 61%, respectively. The net gain in 5-year survival compared with predicted survival in the absence of transplantation fell from 37% (range, 82%-90%) to 16% (range, 91%-99%). Multiple organ failure (16.1%) and sepsis (9.6%) were the major causes of early deaths (<6 months). Recurrent PBC, diagnosed on allograft histology, was found in 68 (17%) patients, at a mean time of 36 months. We were unable to identify any pretransplantation donor or recipient factor, which identified those patients at risk of recurrence, although recurrence was much earlier and more frequently seen in patients receiving tacrolimus (P ‫؍‬ .04). PBC remains a good indication for liver transplantation, with excellent survival rates. The age at transplantation increased although patients tended to be grafted earlier. Survival rates have increased although there is a reduction in the survival benefit. Recurrence may be common, but does not seem to affect medium-term graft survival. (HEPATOLOGY 2001;33:22-27.)Orthotopic liver transplantation (OLT) in humans was first successfully reported by Starzl in 1968 1 ; in the early years, few patients were transplanted and survival rates were poor. With increasing experience; better selection; improved surgical, anesthetic, and microbiological techniques; and the introduction of potent immunosuppressive agents, results have improved considerably. As results have improved, patients have been offered transplantation when they are less ill and more likely to withstand the stresses of the procedure and the postoperative period.Primary biliary cirrhosis (PBC) has been one of the most common indications for liver transplantation in adults. 2 Although the pathogenesis remains uncertain and medical therapy, at best, only slows progression of the disease, the natural history is well understood and there are several prognostic models that have been developed to predict not only survival in the absence of transplantation but also survival after transplantation. 3,4 The indications for transplantation are relatively well defined: either a poor quality of life, usually because of intractable lethargy or pruritus, or an anticipated length of life less than 1 year. 5

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Histological Features Predictive of Recurrence of Primary Biliary Cirrhosis After Liver Transplantation

Abstract: The risk of PBC recurrence is real (8.7%). The presence of plasma cells in the portal infiltrate seems to be an early marker of recurrence of PBC in patients transplanted for this indication.

Cited by 64 publications

References 17 publications

Liver biopsy interpretation for causes of late liver allograft dysfunction

Liver biopsy interpretation for causes of late liver allograft dysfunction

Recurrent primary biliary cirrhosis

Transplantation for Primary Biliary Cirrhosis: Retrospective Analysis of 400 Patients in A Single Center

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