Should trichrome stain be used on all post-liver transplant biopsies with hepatitis C virus infection to estimate the fibrosis score?
Recurrent hepatitis C is virtually universal after liver transplantation; however, an individual patient's clinical course and disease burden are highly variable and difficult to predict. The fibrosis score determined on posttransplant biopsies appears to be a sensitive and specific marker of disease progression and severity. Currently, the fibrosis score is determined from hematoxylin and eosin (H&E)-stained tissue sections supplemented by variable use of trichrome stain or other connective tissue-specific stains. In this study, we compare the fibrosis score on H&E stain with that obtained with trichrome stain in posttransplant liver biopsies of patients with hepatitis C. A total of 197 liver biopsies from 105 allograft patients with hepatitis C were reviewed. The mean fibrosis stage was 1.0 +/- 1.25 with H&E stain versus 1.69 +/- 1.42 with trichrome stain (P < 0.00001). The trichrome staging score was higher in 53.3%, lower in 3%, and the same in 43.7%. The fibrosis stage was raised by 2 or more points in 17.8% and elevated into a bridging category in 14.7%. No significant differences in clinical and laboratory levels were measured in patients with higher fibrosis scores. In conclusion, the hepatic fibrosis score is significantly underestimated by H&E stain in the posttransplant setting in patients with hepatitis C. The fibrosis stage may be an indicator of significant liver damage in these patients. Accuracy of its determination may be most easily facilitated by employment of a connective tissue stain.
Tretheway
David
D
Department of Pathology and Laboratory Medicine, Department of Surgery, Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
Jain
Ashok
A
LaPoint
Randi
R
Sharma
Rajeev
R
Orloff
Mark
M
Milot
Patricia
P
Bozorgzadeh
Adel
A
Ryan
Charlotte
C
D000328:Adult; D001391:Azo Compounds; D001706:Biopsy; D004396:Coloring Agents; D018450:Disease Progression; D004801:Eosine Yellowish-(YS); D005260:Female; D006416:Hematoxylin; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000601:surgery / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008739:Methyl Green; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D001391:Azo Compounds; D004396:Coloring Agents; C017768:trichrome stain; D008739:Methyl Green; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin