Liver transplantationThe Influence of Late Acute Rejection Episodes on Long-Term Graft Outcome After Liver Transplantation
Section snippets
Methods
We followed 1426 liver transplants (OLTx) performed between 1988 and April 2002 for late acute rejection episodes defined as occurring >3 months after OLTx. A total of 1006 follow-up biopsies were grouped into those performed after 6 months, 1, 3, 5, 7, and 10 years, and those with obvious clinical signs for acute rejection. The predictive value of serum parameters was examined in patients prior to routine biopsies. We followed the long-term effects of late acute rejection episodes on chronic
Results
Histologic evidence of acute rejection was found in 52 routine biopsies (5%) among 47 patients (grade 0.5: n = 25 [48%]; grade 1 to 1.5: n = 25 [48%]; grade 2 to 2.5: n = 2 [4%]). Transaminases had significantly (P < .05) increased at 1 month prior to routine biopsies in patients with histologic evidence of rejection (Fig 1, Fig 2). Of patients with histologic evidence of late acute rejection (>3 months post LTx), 79% demonstrated previous early rejection episodes. There was no correlation
Discussion
We observed a predictive increase in transaminase levels prior to routine biopsies in patients with histologic evidence of late acute rejections. In contrast to other organ systems late acute rejection episodes were not associated with the occurrence of chronic graft deterioration in liver grafts.
References (6)
- et al.
J Heart Lung Transplant
(2003) - et al.
Transplant Proc
(2001) - et al.
Clin Transplant
(2004)
Cited by (12)
Chapter 111 - Liver and pancreas transplantation immunobiology
2017, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionLiver Transplant Pathology. Review of Challenging Diagnostic Situations.
2013, Surgical Pathology ClinicsCitation Excerpt :Late acute rejection (LAR) refers to a form of cellular rejection that occurs several months after transplantation and may show different histologic features as compared to typical ACR described earlier. Patients with LAR are more likely to be resistant to increased immunosuppression and may have a higher risk for CR, fibrosis, and graft loss.7–12 This form of rejection has also been variously named centrizonal/parenchymal rejection, hepatitic variant of ACR, or atypical rejection.
Liver and pancreas transplantation immunobiology
2012, Blumgart's Surgery of the Liver, Biliary Tract and PancreasEvaluating and interpreting bile duct changes in liver allograft biopsies
2012, Diagnostic HistopathologyCitation Excerpt :The diagnosis of ACR is based on characteristic morphological features in the allograft biopsy.1 Although most ACR occur early or within the first year post-transplant, late ACR also occurs especially in the context of reduced immunosuppression either due to non-compliance; therapeutic reduction for infection-related complications; malabsorption; or other reasons.2,3 The duct injury in ACR, (Figure 1), involves active infiltration of duct epithelium by immune effector cells, mostly lymphocytes, and therefore with accompanying portal inflammation with or without evidence of endothelial injury manifesting as portal and/or hepatic vein phlebitis.1
What is the long-term outcome of the liver allograft?
2011, Journal of Hepatology