[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/gender	Liver Disease	Days post-LT	Perivenular fibrosis	Hepatocyte necrosis	Congestion	Venulitis	RAI
1- 46 F	Alcohol	244	4	2	3	3	3/3/3=9
2- 46 F	AIH**	249	4	2	3	3	2/3/2=7
3- 45 F	Biliary Cirrhosis	191	4	2	3	3	3/3/3=9
4- 58 F	Alcohol	360	4	2	3	3	3/3/3=9
5- 51 F	HCV	420	2	2	3	3	2/3/3/=8
6- 73 M	PSC*	2650	1	1	1	1	2/2/3=8
7- 49 F	AIH**	471	0	2	1	3	3/2/3=8
8- 39 M	Alcohol	152	0	1	1	3	3/2/3=8
9- 46 M	PSC*	43	0	2	1	1	3/3/2=8
10- 60 M	HCV	180	0	1	0	1	3/3/3=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