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an internationally acceptable grading system, which has al-A panel of recognized experts in liver transplantation ready been developed for kidney, 3 heart, 4 and lung. 5 At the pathology, hepatology, and surgery was convened for Third Banff Conference on Allograft Pathology, a group of the purpose of developing a consensus document for the specialists in liver transplantation from North America, Eugrading of acute liver allograft rejection that is scientifirope, and Asia met for this purpose. cally correct, simple, and reproducible and clinically useful. Over a period of 6 months pertinent issues were DEFINITION OF ACUTE REJECTION discussed via electronic communication media and a consensus conference was held in Banff, Canada in the In general, organ allograft rejection can be defined as, ''an summer of 1995. Based on previously published data and immunological reaction to the presence of a foreign tissue or the combined experience of the group, the panel agreed organ, which has the potential to result in graft dysfunction on a common nomenclature and a set of histopathologi-and failure.'' 2 This report is specifically concerned with acute cal criteria for the grading of acute liver allograft rejec-rejection, recently defined by the international consensus tion, and a preferred method of reporting. Adoption of document on terminology for hepatic allograft rejection 2 as, this internationally accepted, common grading system ''inflammation of the allograft, elicited by a genetic disparity by scientific journals will minimize the problems associ-between the donor and recipient, primarily affecting interlobated with the use of multiple different local systems. ular bile ducts and vascular endothelia, including portal Modifications of this working document to incorporate veins and hepatic venules and occasionally the hepatic artery chronic rejection are expected in the future. (HEPATOL-and its branches.'' 2 Early rejection, cellular rejection, nonduc-OGY 1997;25:658-663.) topenic rejection, rejection without duct loss, and reversible rejection are synonyms for acute rejection that appear in the literature, but their use is discouraged. The general clinical, The success of hepatic transplantation has resulted in its laboratory, and histopathological abnormalities listed below widespread use for treatment of many patients with endstage were derived from the international consensus document.2 liver disease; it is currently offered by more than 100 centers worldwide. One-year survival rates range from 70% to 90%; CLINICAL AND LABORATORY FINDINGSand long-term survival of 50% to 60% of patients is not unViewed from a biological perspective, any recipient's imcommon.1 Therefore, an increasing number of physicians, inmune system will likely be perturbed after transplantation, cluding pathologists, many of whom have no specific training resulting in immune activation. 2 However, viewed from a in transplantation biology, will become involved in the care clinical perspective, because of baseline immunosuppressive of organ all...

MINI ABSTRACTWe present our 14-year experience of liver resection for hilar and peripheral cholangiocarcinomas with an analysis of the clinical and pathologic prognostic factors, overall survival and disease-free survival. ResultsThe survival rates for HCCA and PCCA at one-year were 79% (± 8%) and 67% (± 8%); at three years, 39<'10 (± 10%) and 40% (± 9%); and at five years, 8% (± 7%) and 35% (± 10%), respectively. The disease-free survival rates for HCCA and PCCA were 85% (±1O%) and 77% (±9<'Io) at 1 year; 18% (±11%) and 41% (± 12%) at 3 years; and 18% (±11 %) and 41 % (±12%) at 5 years, respectively. With HCCA, no risk factors were associated with patient survival. For PCCA, multiple tumors (RR=3.5; 95% confidence interval=1.2 to 10.5) and incomplete resection (RR=8.3; 95% confidence interval=2.3 to 29.6) were independently associated with a worse prognosis. For HCCA, there was a trend for lower disease-free survival in female patients (p=O.056; logrank test). For PCCA, tumor size greater than 5 cm was the only factor associated with disease-recurrence (p=0.024; logrank) . Postoperative morbidity and mortality (30 day) were 32% and 14%, respectively for HCCA, and 24% and 3 6% forPCCA. ConclusionsEven though rare, five year survival by resection can be achieved in both HCCA and PCCA; but new adjuvant treatments are clearly needed. ABSTRACTBackground. Long term survival achieved after surgical treatment of hilar

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Background-Because of the rarity of hilar cholangiocarcinoma, its prognostic risk factors have not been sufficiently analyzed. This retrospective study was undertaken to evaluate various pathologic risk factors which influenced survival after curative hepatic resection or transplantation.