Abstract
We examined 27 hept-ectomy specimens to assess the frequency of foam cell endovasculitis and bile duct loss in chronic rejection. Arterial lesions, defined as total occlusion by subintimal foam cells and/or fibromuscular proliferation, were found mainly in hilar and septal arteries, whereas bile duct loss, defined as the absence of bile ducts in more than 50% of portal tracts, affected aminly small tracts. Both were found in 20 livers (74%). In two livers (7%) there was significant bile duct loss but no arterial lesions, whilst in five cases (19%) there were occlusive arterial lesions but no bile duct loss. Small arteries were involved in only 10% of the cases. These results indicate that in one-third of the cases arterial and bile duct lesions develop independently of each other, suggesting different pathogenetic pathways. In addition, liver biopsy may not be pathognomonic since small arteries are involved in only 10% of cases and bile duct loss may not be extensive. In such cases the diagnosis of chronic rejection should only be made in the presence of progressive clinical deterioration.
Similar content being viewed by others
References
Adams D (1991) Immunological aspects of clinical liver transplantation. Immunol Lett 29: 69–72
Adams DH, Husbscher SG, Shaw J, Rothelin R, Neuberger J (1989) Intercellular adhesion molecule 1 on liver allograft during rejection. Lancet II: 1122–1125
Billingham ME (1987) Cardiac transplant atherosclerosis. Transplant Proc 19: 9–25
Bismuth H, Castaing D, Ericzon BD (1987) Hepatic transplantation in Europe: first report of the European Liver Transplant Registry. Lancet II: 674–676
Calne RY (1978) Hepatic transplantation. Surg Clin North Am 58: 321–333
Demetris AJ, Markus BH, Burnham J, Nalesnik M, Gordon RD, Makowka L, Starlz TE (1987) Antibody deposition in liver allografts with chronic rejection. Transplant Proc 19: 121–125
Demetris AJ, Kakizoe S, Oguma S (1990) Pathology of liver transplantation. In: Williams JW (ed) Hepatic transplantation. Saunders, Philadelphia, pp 61–111
Demetris AJ, Belle SH, Hart J, Lewin K, Ludwig J, Snover DC, Tillery GW, Detre K (1991) Intraobserver and interobserver variation in the histopathological assessment of liver allograft rejection. The Liver Transplantation Database (LTD) Investigators. Hepatology 14: 751–755
Desmat VJ (1990) Destructive intrahepatic bile duct diseases. Recent Prog Med 81: 392–398
Eid A, Steffen R, Porayko MK, Beers TR, Kaese DE, Wiesner RH, Krom RA (1989) Beyond 1 year after liver transplantation. Mayo Clin Proc 64: 446–450
Factor SM, Biempica L, Goldfischer S (1977) Intralysomal lipid in long-term maintenance transplant atherosclerosis. Arch Pathol Lab Med 101: 474–477
Freese DK, Snover DC, Sharp HL, Gross CR, Savick SK, Payne WD (1991) Chronic rejection after liver transplantation: a study of clinical, histopathological and imunological features. Hepatology 13: 882–891
Gravanis MB (1989) Allograft heart accelerated atherosclerosis: evidence for cell-mediated immunity in pathogenesis. Mod Pathol 2: 495–505
Grond J, Gouw S, Poppema S, Sloof MJH, Gips CH (1986) Chronic rejection in liver transplants: a histopathologic analysis of failed grafts and antecedent serial biopsies. Transplant Proc 18 [Suppl 4]: 128–135
Hubscher SG, Buckels JA, Elias E, McMaster P, Neuberger J (1990) Vanishing bile-duct syndrome following liver transplantation-is it reversible? Transplantation 51: 1004–1010
Krom RA, Wiesner RH, Rettke SR, Ludwig J, Southorn PA, Hermans PE, Taswell HF (1989) The first 100 liver transplantations at the Mayo Clinic. Mayo Clin Proc 64: 84–95
Leventhal RI, Berman DH, Lasky S, Gavaler JS, Dindzans V, Urban E, Van Thiel DH (1990) Liver transplantation. Initial experience in the Veterans Administration. Dig Dis Sci 35: 673–680
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
Munoz SJ, Friedman LS (1989) Liver transplantation. Med Clin North Am 73: 1011–1039
Oguma S, Belle S, Starzl TE, Demetris AJ (1989) A histometric analysis of chronically rejected human liver allografts. Insights into the mechanisms of bile duct loss: direct immunologic and ischaemic factors. Hepatology 9: 204–209
Pirsch JD, Kalayoglou M, Hafez GR, DÁlessandro AM, Solinger HW, Belzer FO (1990) Evidence that the vanishing bile-duct syndrome is vanishing. Transplantation 49: 1015–1018
Porter KA, Peart WS, Kenyon JR, Joseph NH, Hoehn RJ, Calne RY (1964) Rejection of kidney homotransplants. Ann N Y Acad Sci 120: 472–495
Porter KA, Rendall JM, Stolinski C, Terasaki PI, Machioro TL, Starzl E (1966) Light and EM study of biopsies from 33 human allografts and one isograft s 1 3/4 to 2 1/2 years after transplantation. Ann N Y Acad Sci 129: 615–636
Roser BJ (1984) Mechanisms of graft rejection. In: Calne RY (ed) Transplantation immunology: clinical and experimental. Oxford University Press, Oxford
Rouger P, Gugenheim J, Gane P, Capron-Landereau M, Michel F, Reynes M, Bismuth J (1990) Distribution of the MHC antigens after liver transplantation: relationship with biochemical and histological parameters. Clin Exp Immunol 80: 404–408
Snover DC (1989) Problems in the interpretation of liver biopsies after liver transplantation. Am J Surg Pathol 13 [Suppl 1]: 31–38
Steihoff G, Behrend M, Wonigeit K (1990) Expression of adhesion molecules on lymphocytes/monocytes and hepatocytes in human liver grafts. Hum Immunol 28: 132–127
Steinhoff S (1990) Major histocompatibility complex antigens in human liver transplants. J Hepatol 11: 9–15
Starlz TE, Koep LG, Halgrimson CG (1979) Liver transplantation-1978. Transplant Proc 11: 240–246
Thiru S (1984) The morphology of rejection of renal transplants. In: Calne RY (ed) Transplantation immunology, clinical and experimental. Oxford University Press, Oxford
Vierling JM, Howell CD (1990) Disappearing bile ducts: immunologic mechanisms. Hosp Pract (Off Ed) 25: 141–150
Wiesner RH, Ludwig J, Van Hoek B, Krom RA (1991) Current concepts in cell-mediated hepatic allograft rejection leading to ductopenia and liver failure. Hepatology 14: 721–729
Wight DGD (1989) Analysis of the pathological features of 40 cases of chronic liver transplant rejection. Gut 30: 1500–1501
Wight DGD, Portman B (1987) Pathology of rejection. In: Calne RY (ed) Liver transplantation, 2nd edn. Grune and Stratton, London, pp 388–435
Author information
Authors and Affiliations
About this article
Cite this article
Deligeorgi-Politi, H., White, D.G.D. & Calne, R.Y. Chronic rejection of liver transplants revisited. Transpl Int 7, 442–447 (1994). https://doi.org/10.1007/BF00346040
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00346040