Liver and intrahepatic bile ducts - nontumor
Chronic graft rejection

Author: Komal Arora, M.D. (see Authors page)

Revised: 13 November 2017, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Chronic rejection[TI] liver[TI]

Cite this page: Arora, K. Chronic graft rejection. website. Accessed May 23rd, 2018.
Definition / general
  • Usually irreversible injury of hepatic allografts, likely secondary to ischemic damage to hepatocytes or direct immunologic damage to bile ducts with total loss (vanishing bile duct syndrome)
  • May have insidious onset with no acute component
Microscopic (histologic) description
  • Vanishing bile duct syndrome: loss of intrahepatic bile ducts, minimal portal inflammation
  • Obliterative endarteritis: occlusion by subintimal fibrosis and foam cell change in large and medium sized hilar hepatic arteries and portal vein and distal branches near hilum
  • Also associated ischemic changes of centrilobular ballooning degeneration, pericellular fibrosis and possibly cirrhosis
  • Changes more variable in portal vein
  • Pathognomonic arterial changes are rarely present in needle biopsies
Microscopic (histologic) images

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Portal vein with foam cell change and luminal obliteration