title: 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 (kappa = .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 (kappa = .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 (kappa = .19) to moderate (kappa = .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.
authors.affiliation: Division of Hepatology, Center for Liver Diseases, University of Miami School of Medicine, Miami, FL 33136, USA. aregev@med.miami.edu
authors.forename: Arie
authors.initials: A
authors.lastname: Regev
authors.forename: Enrique
authors.initials: E
authors.lastname: Molina
authors.forename: Rosana
authors.initials: R
authors.lastname: Moura
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Bejarano
authors.forename: Amr
authors.initials: A
authors.lastname: Khaled
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Kris
authors.initials: K
authors.lastname: Arheart
authors.forename: Mariana
authors.initials: M
authors.lastname: Berho
authors.forename: Cinthia B
authors.initials: CB
authors.lastname: Drachenberg
authors.forename: Patricia
authors.initials: P
authors.lastname: Mendez
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Brien
authors.forename: Lennox
authors.initials: L
authors.lastname: Jeffers
authors.forename: Andreas
authors.initials: A
authors.lastname: Tzakis
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Schiff
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006526:Hepatitis C / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies