RESUMEN
Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking. Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series. Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3–6), 3 and 4-late (6–12 and > 12) months] and were assessed for sixteen histological parameters. Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001). Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.
RESUMEN
Liver transplantation is now a well-established therapeutic strategy for irreversible acute and chronic liver diseases. There is a broad spectrum of complications encountered in early and late period after transplantation and these contribute to significant morbidity and mortality. Distinguishing among these complications often requires interpretation of allograft biopsies. Histology is the gold standard for the diagnosis of rejection. However, interpretation of these biopsies is quite challenging due to the atypical and complex histomorphology. Multiple simultaneous insults, effects of immunosuppression (IMS), de novo complications, and presentations distinct from non-transplant setting are a few cardinal concerns. Awareness of the time period of occurrence of various complications, the most characteristic histological features or patterns, and distinguishing features between various complications are crucial. The management can be completely divergent; hence, recognition of dominant problem and interpretation in appropriate clinical context is much needed. This review focuses on histopathology of major complications accountable for early and late graft dysfunction. Tabulation of clinico-pathological features to distinguish various complications helps to solve the conundrums and arrive at the correct diagnosis.
RESUMEN
Background:During the last five years the proportion of living unrelated kidney transplants has increased and DNA tissue-typing methods have become popular in India. This study was carried out to compare the results of tissue - typing by serology and sequence specific primers (SSP) and study the usefulness of 'episode' allograft biopsies for diagnosis of acute graft dysfunction . Materials and Methods:DNA was extracted from whole blood using Qiagen kit. Samples from 60 individuals including thirty patients and their donors were typed by serology and SSP. Fifteen allograft biopsies were performed for suspected acute rejection (AR) cases. Results: Both alleles of HLA - A, B and DR antigen could be determined in 86, 65 and 90% of samples by SSP respectively. There was a discrepancy of 16-40% between SSP and serology. Acute rejection was confirmed in 8/15 biopsies. Graft survival rates were 83 and 76% at one and two years respectively. Neither the graft survival nor the number of AR episodes showed any correlation with the extent of HLA mismatch. SSP was useful in defining A*68, A*66, A*69 and A*33 alleles at private level and A*36, A*74 and A*03 alleles which were blank on serology. Conclusions: SSP has become popular in India due to its simplicity, superior results especially for class II HLA alleles: and episode allograft biopsy is adequate for follow-up of kidney recipients.