Abstract
In this retrospective study, we have investigated the early intragraft inflammatory events of 12 liver allografts leading to chronic rejection. The cytological findings and clinical follow-up were analyzed in detail. Nine patients underwent at least one typical lymphoid activation of acute rejection, and three of them were treated more than once. Diagnosis of rejection was based on biopsy histology, cytology and liver dysfunction. In addition to the acute rejections, cytological analysis demonstrated in 11 of 12 grafts an unidentified lymphoid episode that differed from that of rejection. These lymphoid responses were associated with viral infections; cytomegalovirus (CMV) infection in 10 of 12 patients, hepatitis C virus (HCV) infection in 2 of 12 patients, 1 combined with CMV, and hepatitis B virus (HBV) infection in 1 patient. Graft dysfunction was still seen at the end of the follow-up. Thus, intragraft inflammation caused either by acute rejection or by viral infections may be involved in the induction of chronic rejection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arnold JC, Portman BC, O'Grady JG, Naoumoy NV, Alexander GJ, Williams R (1992) Cytomegalovirus infection persists in the liver graft in the vanishing bile duct syndrome. Hepatology 16: 285–292
Beck S, Barrel BG (1988) Human cytomegalovirus encodes a glycoprotein homologous to MHC class-I antigens. Nature 331: 269–272
Bottomly KA (1988) A functional dichotomy of CD4+ T-cells. Immunol Today 9: 268–271
Deligeorgi-Politi H, Wight DGD, Calne RY (1994) Chronic rejection in liver transplantation revisited. Transpl Int 47: 442–447
Demetris AJ, Qian SG, Sun H, Fung JJ (1990) Liver allograft rejection: an overview of morphologic findings. Am J Surg Pathol 14: 49–63
Freese DK, Snover DC, Sharp HL, Gross CR, Savick SK, Payne WD (1991) Chronic rejection after liver transplantation: a study of clinical, histopathological and immunological features. Hepatology 13: 882–891
Fujinami RS, Nelson JA, Walker I, Oldstone MB (1988) Sequence homology and immunologic cross-reactivity of human cytomegalovirus with HLA-DR beta-chain: a means for graft rejection and immunosuppression. J Virol 62: 100–105
Häyry P, Willebrand E von (1981) Practical guidelines for fine needle aspiration biopsy of human renal allografts. Ann Clin Res 13: 288–306
Häyry P, Isoniemi H, Yilmaz S, Mennander A, Lemström K, Räisänen-Sokolowski A, Koskinen P, Ustinov J, Lautenschlager I, Taskinen E, Krogerus L, Aho P, Paavonen T (1993) Chronic allograft rejection. Immunol Rev 134: 33–81
Howard TK, Klintmalm BG, Cofer JB, Husberg BS, Goldstein RM, Gonwa TA (1990) The influence of preservation injury on rejection in the hepatic transplant recipients. Transplantation 49: 103–107
Lautenschlager I, Höckerstedt K, Ahonen J, Eklund B, Isoniemi H, Korsbäck C, Pettersson E, Salmela K, Scheinin TM, Häyry P (1988) Fine needle aspiration biopsy in the monitoring of liver allografts. II. Applications to human liver allografts. Transplantation 46: 47–53
Lautenschlager I, Höckerstedt K, Häyry P (1991) Fine-needle aspiration biopsy in the monitoring of liver allografts. Transpl Int 4: 54–61
Lautenschlager I, Nashan B, Schlitt HJ, Hoshino K, Ringe B, Tillmann HL, Manns M, Wonigeit K, Pichlmayr R (1994) Different cellular patterns associated with hepatitis C virus reactivation, cytomegalovirus infection and acute rejection in liver transplant patients monitored with transplant aspiration cytology. Transplantation 58: 1339–1345
Ludwig J, Wiesner RH, Batts KP, Perkins JD, Krom RA (1987) The acute vanishing bile duct syndrome (acute irreversible rejection) after orthotopic liver transplantation. Hepatology 7: 476–483
McDonald V, Matolon T, Patel S, Brunner M, Sankary H, Foster P, Williams J (1991) Biliary strictures in hepatic transplantation. J Vasc Interv Radiol 2: 523–528
O'Grady JG, Alexander GJ, Sutherland S, Donaldson PT, Harvey F, Portman B, Calne RY, Williams R (1988) Cytomegalovirus infection and donor/recipient HLA antigens: interdependent co-factors in patho-genesis of vanishing bile-duct syndrome after liver transplantation. Lancet II:302–305
Quiroca J, Colina I, Demetris AJ, Starzl TE, Thiel DH van (1991) Cause and timing of first allograft failure in orthotopic liver transplantation: a study of 177 consecutive patients. Hepatology 14: 1054–1062
Schlitt HJ, Nashan B, Ringe B, Bunzendahl H, Wittekind C, Wonigeit K, Pichlmayr R (1991) Differentiation of liver graft dysfunction by transplant aspiration cytology. Transplantation 51: 786–793
Vierling JM, Fennel RH (1985) Histopathology of early and late human hepatic allograft rejection: evidence of progressive destruction of interlobular bile ducts. Hepatology 5: 1076–1082
Wight DGD, Portman B (1987) Pathology of rejection. In: Calne R (ed) Liver transplantation. Grune & Stratton, London, pp 385–410
Willebrand E von, Pettersson E, Ahonen J, Häyry P (1986) CMV infection, class II antigen expression, and human kidney allograft rejection. Transplantation 42: 364–367
Williams JW, Foster PF, Sankary HN (1992) Role of liver allograft biopsy in patient management. Semin Liver Dis 12: 60–72
Author information
Authors and Affiliations
About this article
Cite this article
Lautenschlager, I., Nashan, B., Schlitt, HJ. et al. Early intragraft inflammatory events of liver allografts leading to chronic rejection. Transpl Int 8, 446–451 (1995). https://doi.org/10.1007/BF00335596
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00335596