Histopathologic Predictors of Early Graft Loss in Viral Hepatitis C Patients with Liver Transplant.
Sara Hafezi-Bakhtiari, George Therapondos, Eberhard L Renner, Nazia Selzner, Oyedele A Adeyi. University Health Network, Toronto, Canada; University of Toronto, ON, Canada
Background: Viral hepatitis C (HCV) with or without hepatocellular carcinoma (HCC) is a major indication for liver transplantation, with more than 80% 3-year graft survival, implying a subset of patients experience graft loss within 2 years. Pathologists play a big role in early diagnosis of graft abnormalities. We have reviewed the causes of graft loss with or without patient death occurring within 2 years and looked back at all earlier pathological materials to identify what features were predictive of eventual outcome.
Design: Patients transplanted for HCV or HCV/HCC between 1991 and May 2010 are identified from our hospital's electronic records. Early graft loss is defined as patient death or re-transplantation within 2 years. All explants as well as all available preceding allograft biopsies were reviewed. Immediate graft losses from surgical complications are excluded.
Results: 44 out of 554 transplanted patients for HCV +/- HCC were selected within our criteria. All explants and pre-loss biopsies were reviewed; 25 of the 44 patients had one to multiple HCC in the explants. Respectively 20.5%, 38.6%, and 40.9% of 44 graft losses occurred in less than 3 months, within the first year; and in the second year. The mean biopsy-to-loss period is 207 days (range 2- 644 days). 19 (36.4%) of these patients had cholestasis beyond the first week of transplant +/- brisk hepatitic activity beginning within 6 months and all lost their grafts to progressive fibrosis from recurrent HCV; 11 of the 19 were classified as the fibrosing cholestatic variant. Chronic rejection was preceded in all affected 5 patients by acute rejection of RAI 7 or greater, PTLD, or zone 3-accentauted “hepatitis”. Non-caseating granulomas were seen in two explants with both patients dying of disseminated tuberculosis within 5 months. All 6 patients with recurrent HCC had either multiple or single lesion greater than 5 cm in the explant, but nothing in their allograft biopsies predicted tumor recurrence. Hepatic artery thrombosis in 3 patients was confirmed by prior zone 3 necrosis/ ischemic cholangiopathy. One patient had portal vein thrombosis and 8 others died of either unrelated (breast carcinoma; hemolytic anemia) or unknown causes.
Conclusions: Predictive histopathological features of shortened graft survival due to aggressive recurrent HCV, chronic rejection, reactivated tuberculosis, and recurrent neoplasms were often present in earlier biopsies or explant, 2-644 days (mean 207 days) prior to graft loss.
Category: Liver & Pancreas
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 193, Wednesday Morning