Table 5

Comparison of the features of recurrent primary sclerosing cholangitis and chronic rejection

Recurrent primary sclerosing cholangitisChronic rejection
Clinical featuresOriginal disease PSC, years after transplantation, selective rise of ALP/GGTTypically within 1st year post-transplant, inadequate immunosuppression, unresolved ACR, or after multiple episodes of ACR
CholangiogramMural irregularity, diverticulum-like outpouchings, beading and “pruning” of bile ducts“Pruning” of peripheral bile ducts
Liver biopsy:
    Portal changesUneven, portal expansion by mixed infiltrate, periductal lamellar oedema, and pericholangitis; focal biliary epithelial degenerative changesNo significant expansion, biliary epithelial degenerative changes in most portal tracts, duct loss
    Interface changesOedema, cholate stasis, ductular reaction, copper deposits in periportal hepatocytesUsually not significant
    CPVUsually not significantOften present
    CholestasisVariableUsually present
    FibrosisSlow progression in time, biliary typePerivenular 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.