Table 3

Histopathological and clinical differences between acute cellular rejection recurrent viral hepatitis C

Acute cellular rejectionViral hepatitis
Portal inflammation++/−
Nature of portal inflammationMixed includes activated lymphocytes, eosinophils +/−, neutrophils +/−Tends to be more monotypic; lymphocytes predominate
Interface activity–*+*
Lobular inflammation–*+
Lobular apoptoses+/–
Zone 3 accentuation of inflammation without phlebitis–*–/+
Zone 3 phlebitis with or without perivenular dropout+–/+
Portal vein phlebitis+–/+
Bile duct injury+–/+
HCV, HBV or other viral serologyNot helpful+
Rate and timing of liver enzyme changesRecent change from baseline and may be associated with suboptimum immunosuppressionUsually smouldering, rarely steep except in FCH
Predominant enzyme patternALT/AST, ALP or mixedALT/AST
  • *Lobular inflammation, interface activity or zone 3 accentuation without phlebitis can be seen in late acute cell-mediated rejection (also known as atypical acute cell-mediated rejection).

  • −, Absent; +/−, usually present but can be absent; −/+, usually absent but can be present occasionally; +, should be present.

  • ALP, alkaline phosphatase; ALT, transaminase; EBV, Epstein–Barr virus; FCH, fibrosing cholestatic hepatitis; HBV, hepatitis B virus; HCV, hepatitis C virus; PTLD, post-transplant lymphoproliferative disease.