Liver and intrahepatic bile ducts-nontumor

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Liver and intrahepatic bile ducts-nontumor

Transplantation

Acute graft rejection

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 22 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Cell mediated, potentially reversible
● Either resolves or progresses to chronic graft rejection
● Banff International Consensus Document criteria: mixed portal inflammation, cholangiolitis and endothelialitis (Hepatology 1997;25:658, Hepatology 2006;44:489)

Treatment
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● Cautious increase in immunosuppression (even if posttransplant lymphoproliferative disorder)

Micro description
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● Portal infiltrate of lymphocytes and variable eosinophils and neutrophils that damage bile ducts and venous endothelium
● No/minimal hepatocyte damage
● Also loss of bile ducts, arteritis, central ischemic damage with ballooning degeneration and hepatocyte dropout

Micro images
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Moderate acute rejection with bile duct damage

Severe acute rejection

Loss of bile ducts

Differential diagnosis
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● EBV associated hepatitis
● Hepatitis C
● Primary biliary cirrhosis
● Terbinafine drug reaction

End of Liver and intrahepatic bile ducts-nontumor > Transplantation > Acute graft rejection

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