Real-time monitoring of acute liver-allograft rejection using the Banff schema1

Abstract

Most acute-rejection episodes are mild and do not lead to clinically significant architectural sequelae. When tested prospectively under real-life and -time conditions, the Banff schema can be used to identify those few patients who are potentially at risk for more significant problems. Creation, capture, and integration of non-free text, or "digital," pathology data can be used to prospectively conduct outcomes-based research in transplantation.

Liver biopsy interpretation for causes of late liver allograft dysfunction

“…present later as ascites because of a Budd-Chiari syndrome or veno-occlusive disease. 63,64,93,96,99 An acute rejection diagnosis is obvious when central perivenulitis occurs in association with other portal-based changes typical of acute rejection; the severity is graded according to standard criteria. 2 Acute rejection is also the most likely diagnosis when central perivenulitis involves a majority of central veins with minimal or absent portal inflammation, except if the original disease was AIH.…”

Intrahepatic cholestasis after liver transplantation

“…Despite major advances in immunosuppression, acute hepatic allograft rejection occurs in the majority of transplant recipients (64%), 49 usually within 7 to 10 days after transplantation. However, mild rejection is reported in 73% of patients in whom acute cellular rejection developed, and moderate or severe acute rejection developed in only 17% of them.…”

“…However, mild rejection is reported in 73% of patients in whom acute cellular rejection developed, and moderate or severe acute rejection developed in only 17% of them. 49 Acute hepatic cellular rejection may present with fever and increased liver enzyme levels, although clinical and laboratory tests are unreliable for diagnosis, and histopathologic analysis remains the gold standard. 49 Acute rejection is associated with lymphocytic cholangitis, a cytotoxic T-cell-mediated nonsuppurative destructive cholangitis of the small bile ducts that can induce cholestasis.…”

“…49 Acute hepatic cellular rejection may present with fever and increased liver enzyme levels, although clinical and laboratory tests are unreliable for diagnosis, and histopathologic analysis remains the gold standard. 49 Acute rejection is associated with lymphocytic cholangitis, a cytotoxic T-cell-mediated nonsuppurative destructive cholangitis of the small bile ducts that can induce cholestasis. 50,51 Recently, Angermuller et al 52 showed that activated Kupffer cells migrate into the rejecting liver and release cytokines, resulting in the loss of NaϩKϩATPase activity.…”

Does Calcineurin Inhibitor Plus Mycophenolate Mofetil Combination Therapy Decrease the Risk of Late Acute Rejection after Liver Transplantation?

“…대부분의 초기 급성거부반응(early acute rejection)은 이 식 이후 수개월 내에 발생하고, 거부반응 치료에 반응을 잘하며, 임상적으로 중요한 합병증의 발생 빈도 역시 낮다 (1). 하지만 급성거부반응에 비해 후기 급성거부반응(late acute rejection)은 중요한 합병증의 발생빈도가 상대적으로 높으며, 환자의 장기 예후에도 나쁜 영향을 미친다 (2,3).…”