[1763] Plasma Cell Hepatitis in Post-Liver Transplant HCV-Infected Patients: The Columbia University Experience

Jad Saab, Marcela Salomao, Elizabeth C Verna, Roger K Moreira. American University Beirut, Beirut, Lebanon; Columbia University, New York, NY

Background: Plasma cell (PC) hepatitis (PCH) in the setting of HCV infection in the post-liver transplantation (LT) period represents a management challenge. Studies showed that PCH likely represents a variant pattern of rejection/immune-mediated graft injury rather than recurrent hepatitis C (rHCV), and may confer poor prognosis. We describe our center's experience with PCH in an attempt to further elucidate its implications.
Design: All cases of chronic hepatitis with “alloimmune” features in HCV-infected, post-LT patients were identified from our files (2006-2011). Inclusion criteria were: positive HCV-RNA with no other viral infections; ≥1 biopsy with PC-rich (>30% PCs) chronic hepatitis with alloimmune features; adequacy (≥5 portal tracts); and no evidence of chronic ductopenic rejection. Clinicopathologic features of each case were re-reviewed. Patient/graft survival were analyzed (Kaplan-Meier and log-rank).
Results: Eighteen cases were included (mean age 57.6 y; M:F= 12:6; mean post-LT time 24.7 m). The table shows the clinicopathologic data. Patient/graft survival compared to the general rHCV post-LT population and a subgroup of these patients diagnosed with acute cellular rejection (ACR) Banff ≥5 (figure).

HAI score*9.4 (6-13)
% of portal PC*37.2 (30-70)
PC clusters †17/18 (94.4)
Portal eosinophils †3/18 (16.6)
Bile duct injury †6/18 (33.3)
Portal endotheliitis †4/18 (22.2)
Central perivenulitis †12/18 (66.6)
Rosettes †3/18 (16.6)
Centrilobular necrosis †10/18 (55.5)
Stage*1.9 (0-3)
Antinuclear antibody †9/11 (81.8)
High serum IgG †6/6 (100)
HCV RNA negative †6/9 (66.6)
Decrease in immunosupression †11/18 (61.1)
*mean (range); † pos/total (%)




Conclusions: Our data further supports that post-LT PCH likely represents a variant of late-onset rejection rather than rHCV based on the presence of other features of immune-mediated injury (central perivenulitis), high IgG, as well as recent decrease in dose of immunosuppression and negative HCV-RNA in most patients. We also confirm the generally poor prognosis associated with these cases, comparable to rHCV patients diagnosed with ACR Banff≥5.
Category: Liver

Monday, March 19, 2012 2:00 PM

Platform Session: Section E, Monday Afternoon

 

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