The Hepatitis Aggressiveness Score (HAS): A Novel Histopathologic Classification System for Posttransplant Recurrent Hepatitis C
Marcela Salomao, Elizabeth C Verna, Roger K Moreira. Columbia University, New York, NY
Background: One or more histopathologic features of fibrosing cholestatic hepatitis C (FCH-C) are commonly seen in conventional post-liver transplant (LT) recurrent hepatitis C (rHCV). We investigated the prognostic value of a novel scoring system for rHCV based solely on the evaluation of FCH-like features when applied to the entire group of post-LT HCV-infected patients.
Design: Liver allograft biopsies from 171 rHCV patients were retrospectively evaluated for FCH-C features (mean post-LT time 361 days). The following FCH-related pathologic criteria were assessed: 1- prominent ductular reaction; 2- cholestasis (canalicular and/or intracellular); 3- prominent hepatocyte ballooning with lobular disarray; 4- periportal sinusoidal fibrosis. Patients with chronic rejection, drug toxicity, biliary/vascular complications were excluded. Graft and patient survival were analyzed (Kaplan-Meier and log-rank) based on number of FCH features present in each case.
Results: rHCV cases were classified into 3 categories: type 1- showing 0/4 criteria (57.3% of cases), found to have favorable prognosis; type 2- patients with 1-2/4 criteria (26.9% of cases), with an intermediate prognosis; and type 3- patients with 3-4 criteria (15.7% of cases), showing extremely aggressive rHCV with clinicopathologic features of FCH-C and rapid progression to graft failure or death in 81.4% (22/27) of cases. Patient and graft survivals were statistically different for each group. Compared to the grading system used at our institution (Batts-Ludwig), survival curves by our proposed scoring system more accurately identified the patients at highest risk for death/graft loss.
Conclusions: Histologic rHCV can reliably be classified into 3 prognostic HAS categories: type 1, or “typical rHCV”, with low mortality/graft failure rate; type 2, or “aggressive rHCV”, with intermediate mortality/graft failure rate; and type 3, or cholestatic hepatitis C, with very high mortality/graft failure rates. Our proposed classification system may be useful in defining FCH-C pathologically and may also be used as a method of stratifying risk of death and graft failure in the entire post-LT rHCV population.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 262, Monday Morning