Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

Abstract

Histopathologic assessment is considered essential for the differentiation of recurrent hepatitis C (RHC) from acute cellular rejection (ACR) after liver transplantation (LT); however, there is limited information regarding its reliability. The aim of this study was to determine the interobserver and intraobserver agreement of the histopathologic diagnosis of RHC vs. ACR, and to determine the reliability of specific histopathologic features for the differentiation of RHC from ACR. Liver biopsy specimens from 105 consecutive patients transplanted for hepatitis C virus (HCV)-related liver disease were studied retrospectively. All the biopsies were performed for evaluation of abnormal liver enzymes within the 1st year after LT. The slides were blindly coded and assessed by 5 liver-transplant pathologists, practicing at 3 medical centers. The pathologists were asked to render a diagnosis, and determine the severity of the disease. Four of the pathologists were asked to determine the presence and severity of 36 histopathologic features. A total of 34 of the samples were then blindly resubmitted to each of the 4 pathologists to determine the intraobserver agreement. There was a slight agreement ( ‫؍‬ .12) among the 5 pathologists on the histopathologic diagnosis. All 5 pathologists were in agreement on the diagnosis of RHC in only 5 patients (5%) and on the diagnosis of ACR in only 2 patients (2%). The best agreement among any 4 pathologists was fair ( ‫؍‬ .20). Slight to moderate agreement occurred on the main histological features considered to be important in the diagnosis of ACR. Intraobserver agreement ranged from slight ( ‫؍‬ .19) to moderate ( ‫؍‬ .42) among 4 pathologists. In conclusion, the histopathologic differentiation of RHC from ACR after LT had relatively low interobserver and intraobserver agreement rates, and hence showed low reliability. Histopathologic assessment should be used cautiously for the differentiation of RHC from ACR post-LT. (Liver

Differential transcriptome patterns for acute cellular rejection in recipients with recurrent hepatitis C after liver transplantation

“…Although liver biopsy is the most common technique to evaluate both ACR and RHC, the accurate interpretation of liver biopsy samples necessitates skilled and expert LT pathologists, and there may be disagreement even among experienced pathologists. 11 Thus, in practice, it can be difficult to distinguish ACR from RHC histopathologically in HCV-positive transplant recipients. Therefore, there is a need to find novel biomarkers expressed distinctly in ACR to assist in establishing a correct diagnosis.…”

Use of an immune functional assay to differentiate recurrent hepatitis C from acute cellular rejection in liver transplant patients

“…As others have noted, 3 the evaluation of a liver allograft biopsy after transplantation from a patient with a history of hepatitis C can be diagnostically challenging. The implications for therapy and possible graft damage with inappropriate treatment require the pathologist and other members of the multidisciplinary transplant team to integrate multiple forms of data when interpreting these types of biopsies.…”

Liver Biopsy in Transplantation: Nonalcoholic Fatty Liver Disease and the Eosinophils

“…Among them the differentiation from recurrent HCV is difficult especially in the early postoperative period because histologic features overlap 43 , but is critical because the treatment strategy is completely opposite. To date, several studies have evaluated the interobserver agreement for the differential diagnosis of ACR and recurrent hepatitis C. Regev et al 43 evaluatedthe interobserver and intraobserver agreement among five experienced pathologists for the diagnosis of 102 biopsy specimens.…”

“…Among them the differentiation from recurrent HCV is difficult especially in the early postoperative period because histologic features overlap 43 , but is critical because the treatment strategy is completely opposite. To date, several studies have evaluated the interobserver agreement for the differential diagnosis of ACR and recurrent hepatitis C. Regev et al 43 evaluatedthe interobserver and intraobserver agreement among five experienced pathologists for the diagnosis of 102 biopsy specimens. The results indicated that both the interobserver and the intraobserver agreement were relatively low, with Kappa scores ranging from 0.20 to 0.24 for interobserver agreement and from 0.19 to 0.42 for intraobserver agreement, indicating only slight to moderate agreement 43 .…”