Table 1

Differential diagnosis of biliary stricture

Histological featureBiliary stricturePreservation injuryAcute rejection
Portal inflammationPredominantly neutrophilicMild non-specific inflammationLymphocytes, plasma cells, and eosinophils (which may predominate when patients are treated with corticosteroid-sparing immunosuppressive regimens)
Bile duct epitheliumRelatively normal nucleus-to-cytoplasm ratio±Reactive changes; increased nucleus-to-cytoplasm ratio
Perivenular mononuclear inflammationAbsentAbsentPresent
Ductular reactionUsually presentMay be prominent if biliary sludge syndrome presentUsually absent
Periductal oedemaUsually presentAbsent
Neutrophils and bile ductsIntraepithelial and intraluminal neutrophils may be present in interlobular ductsNeutrophilic pericholangitis (if severe)No; duct injury by lymphocytes seen infiltrating biliary epithelium
Periportal architectural collapseAbsentMay be present in severe injuryUsually absent
ParenchymaCentrilobular cholestasis in hepatocytes and canaliculi; small clusters of neutrophils in lobules may be seenZonal confluent necrosis early. Hepatocellular, swelling, rounding up, centrilobular cholestasis in hepatocytes and canaliculi