Comparison of the features of recurrent primary sclerosing cholangitis and chronic rejection
| Recurrent primary sclerosing cholangitis | Chronic rejection | |
| Clinical features | Original disease PSC, years after transplantation, selective rise of ALP/GGT | Typically within 1st year post-transplant, inadequate immunosuppression, unresolved ACR, or after multiple episodes of ACR |
| Cholangiogram | Mural irregularity, diverticulum-like outpouchings, beading and “pruning” of bile ducts | “Pruning” of peripheral bile ducts |
| Liver biopsy: | ||
| Portal changes | Uneven, portal expansion by mixed infiltrate, periductal lamellar oedema, and pericholangitis; focal biliary epithelial degenerative changes | No significant expansion, biliary epithelial degenerative changes in most portal tracts, duct loss |
| Interface changes | Oedema, cholate stasis, ductular reaction, copper deposits in periportal hepatocytes | Usually not significant |
| CPV | Usually not significant | Often present |
| Cholestasis | Variable | Usually present |
| Fibrosis | Slow progression in time, biliary type | Perivenular with or without bridging septa, if present. |
ACR, acute cell-mediated rejection; ALP, alkaline phosphatase; CPV, central perivenulitis; GGT, γ glutamyl transpeptidase; PSC, primary sclerosing cholangitis.