Periportal Apoptotic Bodies Are Helpful in Distinguishing Recurrent Hepatitis C from Rejection in Liver Allograft Biopsies
WS Twaddell, JH Lefkowitch. University of Maryland Medical Center, Baltimore, MD; Columbia University Medical Center, New York, NY
Background: Hepatitis C virus (HCV) is the most common indication for liver transplantation worldwide. Histologic differentiation between acute rejection and recurrent chronic hepatitis C following transplantation is a common diagnostic dilemma. This study was undertaken to test the hypothesis that the presence of periportal apoptotic bodies (ABs) in allograft biopsies is a marker of acute rejection and is useful in establishing this diagnosis even in difficult cases where HCV recurrence is also present.
Design: The CUMC Surgical Pathology database was reviewed to select liver biopsies from 3 patient groups: Grp. 1 (non-transplant patients with chronic hepatitis C); Grp. 2 (allograft biopsies showing acute rejection after transplantation for causes other than HCV); and Grp. 3 (allograft biopsies from patients transplanted for chronic hepatitis C). The histologic criteria for acute rejection were those of the Banff consensus document, and recurrent hepatitis C was diagnosed using standard histologic criteria. For each case, H&E slides were evaluated for numbers of lobular and periportal ABs and the percent in each region was compared to the total number per case.
Results: The total number of ABs varied considerably among groups (Table 1).
|HCV- No Transplant||Transplant- No HCV||HCV & Transplant|
|Density: Average ABs/Lobule||0.98 +/- 0.71||1.19 +/- 1.30||1.89 +/- 1.97|
|% ABs in Periportal Zone||12.08 +/- 10.16||23.11 +/- 14.96||19.87 +/- 15.02|
Biopsies from Grp. 1 showed < 20% of all ABs in the periportal regions, whereas Grp. 2 biopsies showed >20% of total ABs in periportal regions. For Grp. 3, two distinct subgroups were identified: biopsies in which rejection was the predominant element showed 18-50% of total ABs to be present in periportal regions, while biopsies showing predominant features of recurrent HCV showed 0-19% of total ABs in periportal regions.
Conclusions: Routine chronic hepatitis C biopsies (non-transplanted) show a range in periportal apoptotic bodies, but very large numbers, particularly if more than 20% of the total number of ABs, favors a diagnosis of acute rejection.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 182, Tuesday Morning