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.
|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|