Current views on rejection pathology in liver transplantation

Area of Science:

• Hepatology
• Transplant Pathology
• Immunology

Background:

• Histological assessment is crucial for diagnosing liver allograft rejection.
• Acute and chronic rejection are well-understood, with liver biopsy as the gold standard.
• Late cellular rejection presents diagnostic challenges due to overlapping features with other conditions.

Purpose of the Study:

• To review difficult and controversial areas in liver allograft rejection pathology.
• To clarify the histological diagnosis of late cellular rejection.
• To discuss overlaps between rejection, de novo autoimmune hepatitis, and recurrent hepatitis C.

Main Methods:

• Review of current literature on liver allograft rejection histology.
• Discussion of histological features, including central perivenulitis.
• Consideration of immunohistochemical markers like C4d.

Main Results:

• Late cellular rejection may exhibit features overlapping with de novo autoimmune hepatitis and idiopathic post-transplant chronic hepatitis.
• Central perivenulitis is a potential indicator of late rejection, requiring differentiation from other causes of necro-inflammation.
• Distinguishing rejection from recurrent hepatitis C remains a challenge.

Conclusions:

• Histological diagnosis of liver allograft rejection, particularly late rejection, requires careful consideration of differential diagnoses.
• Further research is needed to understand the significance of findings like central perivenulitis and C4d deposition.
• Clarification of diagnostic criteria is essential for accurate management of liver transplant recipients.