Cholestasis and injury of interlobular bile ducts occur during rejection of human hepatic allografts. However, knowledge of the nature and progression of bile duct injury during rejection remains incomplete. To define the role of inflammation in bile duct damage, we 888e88ed the light microscopic appearance of hepatic tissue from selected patients in whom allograft failure was solely due to rejection. Nine patients with rejection were easily separated into two groups based on the duration of the allograft survival. The first group (early rejection) consisted of five patients in whom rejection occurred between 13 and 36 days. The second group (late rejection) consisted of four patients in whom rejection occurred between 170 and 912 days. Early rejection was characterized by distortion of bile ducts by adjacent inflammatory cell infiltrates, cytological changes of bile duct epithelial cells and occasionally by frank mononuclear cell inflammation of the epithelium with destruction of the duct. Late rejection was characterized by nonsuppurative destructive cholangitis culminating in the disappearance of interlobular bile ducts. Both groups exhibited histological cholestasis, intact limiting plates, preservation of hepatocytes and positive orcein stains for copper-binding protein. We conclude that the dominant histopathological feature of hepatic allograft rejection is progressive, nonsuppurative destructive cholangitis.
Orthotopic transplantation of liver allografts is being performed with increasing frequency in patients with terminal liver diseases (1-3). Compared with the incidence of rejection observed with renal allografts, rejection of the transplanted liver appears to be much less common in both man (2, 4-6) and in animal models (11). Indeed, no attempts to match the donor and recipient for HLA A, B, C or DR loci are currently made in liver transplantation (1,2), although ABO blood group incompatibility is avoided (1). Whereas the histopathological features of renal allograft rejection have been precisely defined (12), a variety of histological lesions in liver allografts have been attributed to rejection (1, 2, 5, Although rejection of liver allografts is invariably ac-6, 13-17).
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