Liver biopsy interpretation for causes of late liver allograft dysfunction
✍ Scribed by A. J. Demetris
- Publisher
- John Wiley and Sons
- Year
- 2006
- Tongue
- English
- Weight
- 797 KB
- Volume
- 44
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Evaluation of needle biopsies and extensive clinicopathological correlation play an important role in the determination of liver allograft dysfunction occurring more than 1 year after transplantation. Interpretation of these biopsies can be quite difficult because of the high incidence of recurrent diseases that show histopathological, clinical, and serological features that overlap with each other and with rejection. Also, more than one insult can contribute to allograft injury. In an attempt to enable centers to compare and pool results, improve therapy, and better understand pathophysiological disease mechanisms, the Banff Working Group on Liver Allograft Pathology herein proposes a set of consensus criteria for the most common and problematic causes of late liver allograft dysfunction, including late-onset acute and chronic rejection, recurrent and new-onset viral and autoimmune hepatitis, biliary strictures, and recurrent primary biliary cirrhosis and primary sclerosing cholangitis. A discussion of differential diagnosis is also presented. (HEPATOLOGY 2006;44:489-501.) D istinguishing among potential causes of late liver allograft dysfunction can be difficult because of overlapping clinical, serological, and histopathological features. Most problematic biopsies are obtained more than 1 year after transplantation. Currently, diagnoses are made using center-specific criteria, but a standardized set of criteria has not been generally agreed upon. Availability of standardized criteria 1,2 would enable centers to compare and pool results, improve therapy, and better understand pathophysiological disease mechanisms.
Native disease recurrence is a significant problem and can be categorized as follows: (1) infectious (viral hepatitis A, B, C, D.), (2) dysregulated immunity (autoimmune hepatitis [AIH], primary biliary cirrhosis [PBC], primary sclerosing cholangitis [PSC], and sarcoidosis), 3 (3) malignancies, (4) toxic (e.g., alcohol, adverse drug reactions.), (5) metabolic disorders, including nonalcoholic steatohepatitis, and (6) other diseases, such as idiopathic gran-ulomatous hepatitis, 4 postinfantile giant cell hepatitis, 5 and Budd-Chiari syndrome, 6 that are of uncertain etiology or multifactorial in origin. Recurrent infectious and dysregulated immunity diseases pose the most difficult diagnostic challenges and are addressed herein. Some diseases in the remaining categories can also recur, but because they do not usually present diagnostic challenges they are not discussed further.
Long-Term Protocol Biopsies
Most programs obtain biopsies when changes in liver tests represent a significant deviation from baseline values.
Obtaining protocol allograft biopsies in asymptomatic Abbreviations: AIH, autoimmune hepatitis; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis; HCV, hepatitis C virus; LAR, late-onset acute rejection.