Histologic features of allograft livers in patients treated for rejection before biopsy

Liver biopsy is essential for management in liver transplant patients with clinical features suspicious for acute cellular rejection (ACR). As more patients are transplanted for noninfectious indications, it has become increasingly common for them to receive treatment for presumed ACR before biopsy....

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Bibliographic Details
Published in:Human pathology 2023-05, Vol.135, p.11-21
Main Authors: Leonard, Nicole B., Hale, Gillian L., Boylan, Katherine E., Ou, Zhining, Zhang, Chong, Kim, Robin, Chandna, Shaun, Dong, Zachary M., Evason, Kimberley J.
Format: Article
Language:English
Subjects:
Acute cellular rejection
Allografts
Biopsy
Gastrointestinal pathology
Graft Rejection - pathology
Hepatic pathology
Humans
Inflammation - pathology
Liver
Liver - pathology
Retrospective Studies
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Summary:Liver biopsy is essential for management in liver transplant patients with clinical features suspicious for acute cellular rejection (ACR). As more patients are transplanted for noninfectious indications, it has become increasingly common for them to receive treatment for presumed ACR before biopsy. The effect of pretreatment on the classic histologic triad of ACR's mixed portal inflammation, endothelialitis, and bile duct damage is not well described. Here we report a retrospective study of 70 liver transplant biopsies performed on 53 patients for suspected ACR between 2018 and 2021. Thirty-seven biopsies had a clinical diagnosis of ACR after biopsy. Pretreatment with steroids, antithymocyte globulin, or other increased immunosuppression was given before biopsy in 17 of 37 cases; 20 not-pretreated cases acted as controls. A representative hematoxylin and eosin–stained slide from each biopsy was reviewed independently in a blinded fashion by 3 hepatic pathologists, graded according to the Banff system, assigned a Rejection Activity Index (RAI), and assessed for other histologic features. We found that pretreated biopsies had significantly less portal inflammation (P 
ISSN:0046-8177
1532-8392
1532-8392
DOI:10.1016/j.humpath.2023.02.005