The choice of calcineurin inhibitor does not influence centrilobular necrosis after orthotopic liver transplantation

Hassoun, Ziad; Shah, Vijay; Petrovic, Lydia M.

doi:10.1016/s0041-1345(02)02955-x

“…All these findings support the concept that in the setting of CLN, lobular inflammation is a manifestation of AR. 1,10,[12][13][14] Our recent study also supports that notion by showing that lobular inflammation (when all the other etiologies have been excluded) is independently associated with AR in biopsies with CLN. 10 Cholestasis also has been recognized in association with CLN.…”

Section: Commentssupporting

confidence: 79%

“…1,10,[12][13][14] Our recent study also supports that notion by showing that lobular inflammation (when all the other etiologies have been excluded) is independently associated with AR in biopsies with CLN. 10 Cholestasis also has been recognized in association with CLN. 2,10,14 Previous studies showed that the severity of cholestasis did not correlate with any other histopathologic findings, including those of AR.…”

Section: Commentssupporting

confidence: 79%

“…8,9 Our recent study, addressing the issue of CLN after liver transplantation, showed that the CLN may represent a variant or a subgroup of AR, even in the absence of significant PI. 1,[8][9][10] CLN has been associated with an increased incidence of CR and with lower patient and graft survival rates. However, that experience has not been universal.…”

Section: Commentsmentioning

confidence: 99%

“…The persistence of CVE, CLN, and LBI suggested by the authors to be predictive of CR is plausible, and has been implicated in several previous studies; yet, all those features evaluated separately or together also may represent atypical or severe manifestations of AR or, alternatively, may be caused by some other etiologies, de novo, or recurrent diseases (drug toxicity, for example). 1,10,11 The reasons for LBI, in particular, are numerous and heterogeneous, and in the posttransplant setting, those reasons may be even more complex. Furthermore, both lobular inflammation and CLN have been found to respond to antirejection therapy in a number of cases.…”

Section: Commentsmentioning

confidence: 99%

See 2 more Smart Citations

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

Petrovic¹

2003

Liver Transplantation

0

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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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“…10 Cholestasis also has been recognized in association with CLN. 2,10,14 Previous studies showed that the severity of cholestasis did not correlate with any other histopathologic findings, including those of AR. 12 However, a recent study showed that the presence of cholestasis in biopsies with CLN was the strongest independent predictor of the simultaneous presence of AR.…”

Section: Commentsmentioning

confidence: 99%

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

Petrovic

¹

2003

View full text Add to dashboard Cite

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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