[1574] Sinusoidal Obstruction Syndrome and Ascites Resulting from Severe Acute Cellular Rejection Post Liver Transplantation

C Fan, MH Sanei, TD Schiano, MI Fiel. Mount Sinai Medical Center, New York, NY; Isfahan Univ, Isfahan, Islamic Republic of Iran

Background: Ascites formation post liver transplantation (LT) is multifactorial. Sinusoidal obstruction syndrome (SOS) is a rare cause of ascites post-LT and has been rarely reported to occur as a sequela of acute cellular rejction (ACR). We sought to examine the histology of patients developing ascites in the setting of ACR.
Design: Using the Mount Sinai Pathology database, we identified 5 patients with ACR developing ascites and another 5 patients who had severe ACR without ascites (control). Degree of congestion, central venulitis, and hepatocyte necrosis were each scored: 0 = absent; 1 mild; 2 moderate and 3 severe; perivenular fibrosis was scored: 0 absent; 1 mild; 2 fibrous septa present in zone 3; 3 numerous fibrous septa beyond zone 3; and 4, bridging fibrous septa. Rejection activity index (RAI) was based on the Banff criteria. None of the baseline donor liver showed fibrosis.
Results: Note that the patients with ascites had mean perivenular fibrosis = 3.7; all having score of 3 for congestion, central venulitis and hepatocyte necrosis. Serological work up for other causes was negative. All 5 control cases had negligible perivenular fibrosis (mean 0.25), minimal congestion (mean 0.75) and no hepatocyte necrosis.

1
Pts age/genderLiver DiseaseDays post-LTPerivenular fibrosisHepatocyte necrosisCongestionVenulitisRAI
1- 46 FAlcohol24442333/3/3=9
2- 46 FAIH**24942332/3/2=7
3- 45 FBiliary Cirrhosis19142333/3/3=9
4- 58 FAlcohol36042333/3/3=9
5- 51 FHCV42022332/3/3/=8
6- 73 MPSC*265011112/2/3=8
7- 49 FAIH**47102133/2/3=8
8- 39 MAlcohol15201133/2/3=8
9- 46 MPSC*4302113/3/2=8
10- 60 MHCV18001013/3/3=9
Cases 1-5, Control 6-10; **autoimmune hepatitis; *primary sclerosing cholangitis




Conclusions: Severe ACR resulting in SOS may be the cause of ascites formation post-LT. The presence of significant perivenular fibrosis, hepatocyte necrosis and congestion in the setting of severe ACR may signify a poor prognosis for recovery.
Category: Liver & Pancreas

Tuesday, March 23, 2010 9:30 AM

Poster Session III # 241, Tuesday Morning

 

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