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The significance of microabscesses in liver transplant biopsies: a clinicopathological study
L W Lamps1, C W Pinson, D S Raiford
1Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract:
Parenchymal microabscesses (MA) in liver transplant biopsies are frequently associated with cytomegalovirus (CMV) infection. However, other potential causes of MA have not been fully investigated. We studied additional etiologies for MA via histological evaluation and clinicopathological correlation. Three hundred seventy-two liver transplant biopsies from 97 patients (from 1991 to 1997) were reviewed and stained immunohistochemically for CMV. Numerous histological features were evaluated including size and number of MA, lobular and portal inflammation, and cholestasis. Medical records were reviewed for radiographic, laboratory, and other clinical data from the time of biopsy. The chi2 or Fisher's Exact test and ANOVA with adjusted multiple comparisons were used to determine statistical significance. Sixty-two of 372 biopsies (17%) from 43 patients contained MA. Biopsies were obtained between 4 days and 2.3 years posttransplant (median, 14 days). Nineteen percent of biopsies had CMV infection at the time of biopsy; 27% were associated with other bacterial, viral, or fungal infections; 10% had graft ischemia; 15% had biliary obstruction/cholangitis; 3% had a combination of ischemia and sepsis; and no explanation was found in 26% of biopsies. Numerous MA within a biopsy (>9) correlated with CMV infection (P <.005); no other histological features, including size of MA, correlated with the etiology of MA. Overall, 43 of 97 (44%) liver transplantation patients at our institution had biopsies demonstrating MA at some point in their posttransplantation course. CMV infection appears responsible for only a minority of cases. MA, although nonspecific, are an important histological finding in numerous conditions that may have a significant impact on both graft survival and overall patient morbidity.
Insights
Parenchymal microabscesses in liver transplants are not always due to cytomegalovirus (CMV). This study found multiple causes for these findings, highlighting their importance in transplant patient outcomes.
Area of Science:
- Hepatology
- Transplant Pathology
- Infectious Diseases
Background:
- Parenchymal microabscesses (MA) in liver transplant biopsies are often linked to cytomegalovirus (CMV) infection.
- The full spectrum of etiologies for MA in this context remains incompletely understood.
Purpose of the Study:
- To investigate additional causes of MA in liver transplant biopsies beyond CMV.
- To correlate histological findings with clinical data to identify potential etiologies.
Main Methods:
- Retrospective review of 372 liver transplant biopsies from 97 patients.
- Immunohistochemical staining for CMV and evaluation of various histological features.
- Correlation with clinical, radiographic, and laboratory data.
Main Results:
- MA were identified in 17% of biopsies (43% of patients).
- Cytomegalovirus (CMV) infection was present in 19% of MA cases; other infections, graft ischemia, and biliary obstruction were also identified.
- A high number of MA (>9) correlated with CMV infection, but MA size did not correlate with etiology.
Conclusions:
- Cytomegalovirus (CMV) infection accounts for only a minority of parenchymal microabscesses in liver transplant biopsies.
- MA are nonspecific but significant histological findings associated with diverse conditions impacting graft survival and patient morbidity.