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Endotheliitis in chronic viral hepatitis: a comparison with acute cellular rejection and non-alcoholic

Matthew M Yeh1, Anne M Larson, Bruce Y Tung

  • 1Department of Pathology, University of Washington School of Medicine, Seattle, Washington 98195-6100, USA. myeh@u.washington.edu

The American Journal of Surgical Pathology
|May 26, 2006
PubMed

Insights

Endotheliitis, a feature of liver transplant rejection, is also common in chronic hepatitis C and B. Its presence in viral hepatitis is less severe than in acute cellular rejection, aiding diagnosis.

Area of Science:

  • Transplant Pathology
  • Hepatology
  • Immunology

Background:

  • Endotheliitis is a key histologic feature of acute cellular rejection (ACR) in liver allografts.
  • This change is not specific and can occur in various chronic liver diseases.
  • Recurrence of chronic hepatitis C is common after liver transplantation, posing diagnostic challenges.

Purpose of the Study:

  • To investigate the prevalence and severity of endotheliitis in chronic liver diseases, specifically hepatitis C (HCV), hepatitis B (HBV), and nonalcoholic steatohepatitis (NASH).
  • To compare endotheliitis scores in chronic liver diseases with those in ACR.
  • To assess the correlation between endotheliitis and overall liver disease activity.

Main Methods:

  • Evaluation of 128 nontransplant liver biopsies (HCV, HBV, NASH) and 80 posttransplant ACR biopsies.
  • Semiquantitative scoring of subendothelial and supraendothelial endotheliitis in portal and central regions (0-4 scale).
  • Pathologist blinding to clinical history and independent scoring by two pathologists.

Main Results:

  • Mean endotheliitis scores >1 were observed in 60% of HCV, 35% of HBV, and 6% of NASH patients.
  • Portal endotheliitis scores were significantly higher in viral hepatitis (HCV, HBV) than in NASH.
  • Endotheliitis scores in ACR were significantly higher than in all chronic liver disease groups.

Conclusions:

  • Minimal to mild subendotheliitis is common in chronic hepatitis C and B, but less severe than in ACR.
  • The degree of endotheliitis correlates with inflammatory activity in chronic viral hepatitis.
  • Distinguishing endotheliitis in recurrent viral hepatitis from ACR is crucial to avoid unnecessary immunosuppression.

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