Central venulitis in the allograft liver: a clinicopathologic study

Area of Science:

• Hepatology
• Transplantation Immunology
• Nephrology

Background:

• Central venulitis is a liver allograft lesion characterized by inflammation of terminal hepatic venules and hepatocyte dropout.
• Previously, central venulitis was considered a manifestation of acute rejection, but some suggested it indicated tacrolimus hepatotoxicity.

Purpose of the Study:

• To compare clinicopathologic features of isolated central venulitis with combined central venulitis and portal acute rejection.
• To determine if central venulitis is a manifestation of acute rejection or drug toxicity.

Main Methods:

• Compared 30 episodes of isolated central venulitis with 22 episodes of combined central venulitis and portal acute rejection in 27 patients.
• Patients received either tacrolimus or cyclosporine for immunosuppression.
• Analyzed clinicopathologic features, drug levels, and treatment responses.

Main Results:

• No significant differences were found between isolated and combined central venulitis groups, except for a milder inflammatory component in isolated cases.
• No patients had drug levels exceeding therapeutic ranges or clinical evidence of drug toxicity.
• Antirejection therapy was effective in 93% of isolated central venulitis cases and 86% of combined cases, with documented histologic regression.

Conclusions:

• Findings contradict the notion of central venulitis as drug toxicity.
• Central venulitis is indicative of acute allograft rejection.
• Prompt antirejection therapy is effective in resolving central venulitis.