Utilization of Acidophil Bodies in the Diagnosis of Recurrent Hepatitis C Infection after Orthotopic Liver Transplantation

Abstract

Background:The distinction between acute rejection and early recurrent hepatitis C infection (RHCV) in the setting of orthotopic liver transplantation is often difficult. In liver biopsies acidophil bodies and lobular hepatitis are used to suggest a diagnosis of RHCV over rejection, however, the reliability of this practice has not been established. Because portal tract changes in RHCV and rejection often overlap, we sought to determine whether the degree of hepatocyte acidophil body formation seen on liver biopsies could be used to distinguish between these two conditions. Methods: Quantification of acidophil bodies was performed on liver biopsies in orthotopic liver transplant patients with RHCV (n ‫؍‬ 10), non-hepatitis C orthotopic liver transplant patients with uncomplicated rejection episodes (n ‫؍‬ 10) and non-transplant patients with chronic hepatitis C infection (n ‫؍‬ 10). Hematoxylin and Eosin stained slides from all three groups were randomized and tissue segments 1.0 cm in length and of variable width (0.04 -0.13 cm) were examined at 200؋ magnification in a blinded fashion by two pathologists in order to quantify the number of acidophil bodies/cm

What is expected from the pathologist in the diagnosis of viral hepatitis?

“…In the early stage of graft reinfection (0-2 months after transplantation), morphologic alterations are minor and nonspecific and cannot be distinguished from those associated with acute rejection or preservation/reperfusion injury. Histologic features in early post transplant biopsies predicting a more aggressive course include increased severity of necroinflammation, macrovesicular steatosis, and prominent [101,[103][104][105]. In HCV genotype 3, severe steatosis may be the initial histologic manifestation of recurrent hepatitis [17].…”

Concurrent increase in mitosis and apoptosis: a histological pattern of hepatic arterial flow abnormalities in post-transplant liver biopsies

“…One of the classic patterns in allograft liver pathology is that of bland lobular necrosis, which suggests recurrent viral hepatitis in the right clinical context. 2 In this study, we describe a pattern that can closely mimic recurrent hepatitis C, but overall has more hepatic apoptosis and also has increased mitotic activity. This pattern in our case series was strongly associated with hepatic arterial problems, most of which were hepatic artery thromboses or stenosis.…”

“…In this setting, lobular spotty necrosis in the absence of significant inflammation is a key histological pattern that suggests early recurrent viral hepatitis. 1,2 Preservation injury in some cases may also be in the differential, but in most cases, the time of the biopsy since transplantation makes preservation injury unlikely. Likewise, preservation injury can usually be excluded based on available liver function tests, as they will typically reveal continuous abnormalities after the transplantation, 3 in contrast to the abrupt onset of increased liver function tests that is more typical of recurrent viral hepatitis and acute cellular rejection.…”

Apoptosis and progression of hepatic fibrosis in hepatitis C patients

“…In another study [29], acidophilic bodies were quantified in liver biopsies from patients with recurrent HCV infection after liver transplant, in patients with non-complicated graft rejection due to other etiologies (non-HCV), and in patients carrying non-transplanted HCV. A doubling in the proportion of acidophilic bodies at the initial stage was found in the group with recurrent HCV infection after grafting, when compared to the other groups, showing the importance of an evaluation of apoptosis for differential diagnosis between reinfection and rejection [22][23][24][25][26][27][28][29].…”