Histopathological and clinical differences between acute cellular rejection recurrent viral hepatitis C
| Acute cellular rejection | Viral hepatitis | |
| Portal inflammation | + | +/− |
| Nature of portal inflammation | Mixed 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 serology | Not helpful | + |
| Rate and timing of liver enzyme changes | Recent change from baseline and may be associated with suboptimum immunosuppression | Usually smouldering, rarely steep except in FCH |
| Predominant enzyme pattern | ALT/AST, ALP or mixed | ALT/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.