Liver Allografts for Primary Biliary Cirrhosis in 101 Patients: Diagnosis and Followup Outcome of Histopathological Abnormalities.
Sara Hafezi-Bakhtiari, Oyedele A Adeyi. University of Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
Background: While data exist for post-transplant outcomes in the more common indications for liver transplant, those for primary biliary cirrhosis (PBC) have largely been limited to small case series with varied outcomes. For example recurrent PBC (rPBC) is reported to be as low as 9% and high as 50%. Also other causes of graft abnormalities other than chronic rejection (CR) and rPBC in this patient group have not been documented. This study of a large cohort over a 22-year period aims at addressing these issues.
Design: Patients who received liver transplant from 1987-2009 and with a minimum of 1-year follow-up were identified. Clinical information was retrieved from transplant electronic record and corresponding pathologic material reviewed in cases where these were available.
Results: 101 PBC patients with primary grafts were included. Patients were on Cyclosporin or Tacrolimus-based regimen and followed-up for 133 months (range 12.2 -274 months). All biopsies were performed for indication and available in 71 (70.3%) patients. Of 30 patients with no biopsy, 25 are alive with functioning grafts; 5 died of graft unrelated causes. rPBC was present in 9 (8.9%) patients at a mean of 98.7 months post-transplant, resulting in 1 (0.9%) graft failure 78 after diagnosis. CR was documented in 11 patients (10.3%) after a mean of 96.8 months; 3 (2.9%) resulted in graft failure within 30-60 months. Overall graft failure occurred in 6 patients (5.9%) including 2 from causes other than CR or rPBC. Features favoring CR over rPBC are cholestasis >> fibrosis; absence of ductular reaction; and no periportal copper. rPBC showed ductular reaction in portal tracts with and without florid duct lesions but cholestasis was rare. Late acute cellular rejection that responded to treatment was present in 60.1% of biopsies; de novo HCV (2.8%); and idiopathic hepatitis (2.8%) were some other findings. Only 6 of 33 deaths were due to graft failure; 27 died with functioning graft from sepsis, metastatic carcinoma; myocardial infarction, CVA, and others.
Conclusions: Excellent long-term graft survival for PBC is confirmed. CR and rPBC occurred in 10.3% and 8.9% of patients respectively. Neither was inevitably “fatal” to the graft although CR was 3 times more likely to result in graft loss, and it was possible to histologically differentiate one from the other. Late-occurring acute cellular rejection was a common cause of clinical graft dysfunction, but typically responded to routine treatment.
Category: Liver & Pancreas
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 192, Wednesday Morning