IHC for Foxp3, CD4 and CD8 Lymphocytes Aid in the Diagnosis of Acute Rejection vs. HCV Recurrence in Liver Transplant Biopsies
A Tholpady, G Krueger, B Zhao, RE Brown, N Tatevian. UT Health Science Center at Houston, Houston, TX
Background: End-stage liver disease due to Hep C is the most common indication for liver transplantation. Fresh donor liver transplant is inevitably doomed to recurrent HCV (rHCV) in these patients, which is further complicated by the risk of acute rejection (AR). Distinguishing between the two can be a diagnostic challenge by H & E alone. In this study, we used the IHC markers CD4, CD8 and Foxp3-a marker for regulatory Tcells (Tregs)-to aid in diagnosis.
Design: Biopsies from explant liver and donor pre- and post-transplant over the course of 132 weeks were stained with H&E and scored for rHCV and AR by the Scheuer system and rejection activity index (RAI). IHC was performed with Foxp3, CD4 and CD8. Average numbers of positive cells were calculated in 10 high power fields in liver lobules (LL) and in 10 portal areas (PA) in each biopsy.
Results: As seen here:
|Explant (cirrhotic liver, S 3-4)||0||2.2||32.2||0.8||7|
|No AR, no rHCV||1.4||3.6||29.4||0.4||3|
|rHCV (G 2/4, S 1/4) no AR||132||4.8||81.3||1.8||7.6|
|rHCV (G 2/4, S 1/4), AR?||111||8.3||50||3.7||9|
|rHCV (G 2/4, S 1/4), AR?||85.7||10||88||1.8||23.9|
|rHCV (G 3/4, S 3/4), RAI=6/9||60||28.9||206||4.3||33.5|
|rHCV (G3/4, S 1/4), RAI=5/9||128||33.2||138||6.1||33.8|