Centrilobular histopathologic changes in liver transplant biopsies.
We evaluated centrilobular histologic changes seen on post-orthotopic liver transplantation (OLT) biopsies to refine the pathologic diagnosis by systematic study of morphologic and clinical data with possible identification of prognostic criteria. A total of 110 biopsies with zone 3 pathology from 59 patients were reviewed and correlated with clinical findings. Within the first 6 months post-OLT (group I), 39 of 47 patients had combinations of centrilobular hepatocytic dropout, ballooning, and cholestasis on single or multiple biopsies attributed to perioperative ischemic/perfusion injury; 12 of 39 patients with all 3 features present had increased incidence of biliary complications and sepsis and decreased 1-year patient and graft survival; 17 of 39 patients with 2 of the 3 features had increased biliary complications but not decreased 1-year survival; and the remaining 8 of 47 patients had central venulitis associated with acute cellular rejection. After 6 months post-OLT (group II), 14 patients, including 2 from group I, had biopsies with centrilobular pathology; 8 of 14 had central venulitis related to rejection (acute, 4; chronic, 4), and fibrosis was seen in 8 (rejection, 6; cardiac problems, 2). In conclusion, combinations of centrilobular hepatocytic ballooning, dropout, and cholestasis are seen in association with reversible or irreversible ischemic/perfusion damage in the early post-OLT period. The presence of all 3 features is associated with a poor outcome. Central venulitis as a feature of acute/chronic rejection is seen at any time post-OLT and is not a predictor of poor graft/patient survival.
Khettry
Urmila
U
Department of Pathology, Lahey Clinic Medical Center, Burlington, MA, USA.
Backer
Amy
A
Ayata
Gamze
G
Lewis
W David
WD
Jenkins
Roger L
RL
Gordon
Fredric D
FD
D001706:Biopsy; D002780:Cholestasis, Intrahepatic / Q000473:pathology; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000473:pathology*; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology*; D009336:Necrosis; D015427:Reperfusion Injury / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D014657:Vasculitis / Q000473:pathology; D014699:Venules / Q000473:pathology