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)|
|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)|