Orthotopic Liver Transplantation: A Pathological Study of 63 Serial Liver Biopsies from 17 Patients with Special Reference to the Diagnostic Features and Natural History of Rejection

Authors

  • Dale C. Snover,

    Corresponding author
    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
    • Dale C. Snover, M.D., Laboratory Medicine and Pathology, Box 609 Mayo, University of Minnesota Medical School, 420 Delaware Street, S.E., Minneapolis, Minnesota 55455
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    • Dr. Snover is a Junior Faculty Clinical Fellow of the American Cancer Society.

  • Richard K. Sibley,

    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
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  • Deborah K. Freese,

    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
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  • Harvey L. Sharp,

    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
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  • Joseph R. Bloomer,

    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
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  • John S. Najarian,

    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
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  • Nancy L. Ascher

    1. Departments of Laboratory Medicine and Pathology, Pediatrics, Medicine and Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455
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  • This paper was presented in part at the 73rd Annual Meeting of the International Academy of Pathology, San Francisco, California, March 12–16, 1984, Digestive Disease Week, New Orleans, Louisiana, May 20–23,1984 and the 10th International Congress of the Transplantation Society, Minneapolis, Minnesota, August 26–31, 1984.

Abstract

The histopathological features of orthotopic liver transplants were evaluated in 63 serial biopsy specimens from 17 patients. Biopsies were taken at the time of insertion of the liver (six biopsies), at the time of development of liver function abnormalities (11 biopsies) and as follow-up to previously abnormal biopsies (46 biopsies). The biopsies taken at the time of insertion all showed diffuse hepatocellular ballooning with confluent areas of necrosis in one case. Biopsies taken at the time of onset of rejection (nine cases) all showed a mixed portal inflammatory infiltrate, bile duct damage and central or portal vein endothelialitis (i.e., attachment of lymphocytes to the vein endothelium). Follow-up biopsies showed several patterns including: (i) resolution of changes of acute rejection with subsequent development of recurrent acute or chronic rejection (four cases); (ii) prolonged acute rejection simulating extrahepatic biliary obstruction (four cases); (iii) prolonged acute rejection with predominance of eosinophils simulating a drug reaction (one case); and (iv) rapidly progressive acute rejection leading to death (one case). Biopsy of the transplanted liver at the time of transplantation is useful to provide a baseline for comparison with later biopsies. Biopsy at the time of onset of changes in liver function is essential to confirm the presence of rejection prior to alteration of immunosuppression.

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