Clinicopathological analysis of liver allograft biopsies with late centrilobular necrosis : A comparative study in 54 patients
Centrilobular necrosis (CLN) in liver allografts can be a difficult lesion to interpret histologically. Although long recognized in association with developing chronic rejection, recent studies have described the lesion in association with a number of other disease processes. To clarify the histolog...
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Veröffentlicht in: | Transplantation 2000-04, Vol.69 (8), p.1599-1608 |
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description | Centrilobular necrosis (CLN) in liver allografts can be a difficult lesion to interpret histologically. Although long recognized in association with developing chronic rejection, recent studies have described the lesion in association with a number of other disease processes. To clarify the histologic features that could allow a specific diagnosis to be made and to determine the outcome in different diagnostic groups, we assessed biopsies from 54 patients with CLN.
Biopsies were classified as CLN with acute cellular rejection (ACR), CLN with hepatitis, CLN with developing chronic rejection (CR), and CLN of other etiology. Histologic features were assessed and then compared between groups, and clinical outcomes were noted.
Discriminating features for the different groups were as follows: CLN and ACR showed bile duct injury, endothelialitis, and acinar congestion. CLN and CR showed severe bile duct injury, bile duct loss, or centrilobular swelling. CLN and hepatitis was often a diagnosis of exclusion, although interface hepatitis was more common in this group. Cases of autoimmune hepatitis usually demonstrated plasma cell predominance in the portal and acinar inflammatory infiltrate. Significantly, there was considerable overlap in the histologic features between the groups, accounting for the diagnostic difficulty. Patients in whom the CLN was associated with CR or vascular complications generally required retransplantation or died, but in the groups with ACR and hepatitis, the outcome was more favorable.
With regard to most liver allograft biopsies showing late CLN, it is possible to make a specific diagnosis despite overlapping histologic features; this allows specific therapy to be instituted. Ultimately this is likely to contribute to improved graft survival. |
doi_str_mv | 10.1097/00007890-200004270-00014 |
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Biopsies were classified as CLN with acute cellular rejection (ACR), CLN with hepatitis, CLN with developing chronic rejection (CR), and CLN of other etiology. Histologic features were assessed and then compared between groups, and clinical outcomes were noted.
Discriminating features for the different groups were as follows: CLN and ACR showed bile duct injury, endothelialitis, and acinar congestion. CLN and CR showed severe bile duct injury, bile duct loss, or centrilobular swelling. CLN and hepatitis was often a diagnosis of exclusion, although interface hepatitis was more common in this group. Cases of autoimmune hepatitis usually demonstrated plasma cell predominance in the portal and acinar inflammatory infiltrate. Significantly, there was considerable overlap in the histologic features between the groups, accounting for the diagnostic difficulty. Patients in whom the CLN was associated with CR or vascular complications generally required retransplantation or died, but in the groups with ACR and hepatitis, the outcome was more favorable.
With regard to most liver allograft biopsies showing late CLN, it is possible to make a specific diagnosis despite overlapping histologic features; this allows specific therapy to be instituted. Ultimately this is likely to contribute to improved graft survival.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/00007890-200004270-00014</identifier><identifier>PMID: 10836369</identifier><identifier>CODEN: TRPLAU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Acute Disease ; Adolescent ; Adult ; Biological and medical sciences ; Biopsy ; Child ; Child, Preschool ; Chronic Disease ; Female ; Graft Rejection - pathology ; Hepatitis - pathology ; Humans ; Infant ; Liver - pathology ; Liver Circulation ; Liver Transplantation - pathology ; Liver, biliary tract, pancreas, portal circulation, spleen ; Male ; Medical sciences ; Middle Aged ; Necrosis ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Thrombosis - pathology ; Transplantation, Homologous</subject><ispartof>Transplantation, 2000-04, Vol.69 (8), p.1599-1608</ispartof><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c285t-6b83e1e7eb17e3ff6b8d22ff59afa80539bc2e4e0d6d9a07687a5521f4e532f43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1483955$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10836369$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>NAKAZAWA, Y</creatorcontrib><creatorcontrib>WALKER, N. I</creatorcontrib><creatorcontrib>KERLIN, P</creatorcontrib><creatorcontrib>STEADMAN, C</creatorcontrib><creatorcontrib>LYNCH, S. V</creatorcontrib><creatorcontrib>STRONG, R. W</creatorcontrib><creatorcontrib>CLOUSTON, A. D</creatorcontrib><title>Clinicopathological analysis of liver allograft biopsies with late centrilobular necrosis : A comparative study in 54 patients</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>Centrilobular necrosis (CLN) in liver allografts can be a difficult lesion to interpret histologically. Although long recognized in association with developing chronic rejection, recent studies have described the lesion in association with a number of other disease processes. To clarify the histologic features that could allow a specific diagnosis to be made and to determine the outcome in different diagnostic groups, we assessed biopsies from 54 patients with CLN.
Biopsies were classified as CLN with acute cellular rejection (ACR), CLN with hepatitis, CLN with developing chronic rejection (CR), and CLN of other etiology. Histologic features were assessed and then compared between groups, and clinical outcomes were noted.
Discriminating features for the different groups were as follows: CLN and ACR showed bile duct injury, endothelialitis, and acinar congestion. CLN and CR showed severe bile duct injury, bile duct loss, or centrilobular swelling. CLN and hepatitis was often a diagnosis of exclusion, although interface hepatitis was more common in this group. Cases of autoimmune hepatitis usually demonstrated plasma cell predominance in the portal and acinar inflammatory infiltrate. Significantly, there was considerable overlap in the histologic features between the groups, accounting for the diagnostic difficulty. Patients in whom the CLN was associated with CR or vascular complications generally required retransplantation or died, but in the groups with ACR and hepatitis, the outcome was more favorable.
With regard to most liver allograft biopsies showing late CLN, it is possible to make a specific diagnosis despite overlapping histologic features; this allows specific therapy to be instituted. Ultimately this is likely to contribute to improved graft survival.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chronic Disease</subject><subject>Female</subject><subject>Graft Rejection - pathology</subject><subject>Hepatitis - pathology</subject><subject>Humans</subject><subject>Infant</subject><subject>Liver - pathology</subject><subject>Liver Circulation</subject><subject>Liver Transplantation - pathology</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Necrosis</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Thrombosis - pathology</subject><subject>Transplantation, Homologous</subject><issn>0041-1337</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkE1v3CAQhlGVqtmm_QsVhyo3t2DA4NyiVfohReqlPVtjPDRUrHEAJ9pLf3vZ7jYplwHxvDOahxDK2QfOev2R1aNNz5r2cJOtZk2tXL4gG66EbDpm2BnZ1C_ecCH0OXmd86-KKKH1K3LOmRGd6PoN-b0NfvY2LlDuYog_vYVAYYawzz7T6GjwD5gohPqXwBU6-rhkj5k--nJHAxSkFueSfIjjGiDRGW2Kh_AVvaY27hZIUGoTmss67amfqZK0jvM1ld-Qlw5CxrenekF-fLr5vv3S3H77_HV7fdvY1qjSdKMRyFHjyDUK5-p7alvnVA8OTN2qH22LEtnUTT0w3RkNSrXcSVSidVJckMtj3yXF-xVzGXY-WwwBZoxrHjTnsudGVdAcwcMSOaEbluR3kPYDZ8PB_fDP_fDkfvjrvkbfnWas4w6n_4JH2RV4fwIgV80uwWx9fuakEb1S4g9Ke45f</recordid><startdate>20000427</startdate><enddate>20000427</enddate><creator>NAKAZAWA, Y</creator><creator>WALKER, N. I</creator><creator>KERLIN, P</creator><creator>STEADMAN, C</creator><creator>LYNCH, S. V</creator><creator>STRONG, R. W</creator><creator>CLOUSTON, A. D</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000427</creationdate><title>Clinicopathological analysis of liver allograft biopsies with late centrilobular necrosis : A comparative study in 54 patients</title><author>NAKAZAWA, Y ; WALKER, N. I ; KERLIN, P ; STEADMAN, C ; LYNCH, S. V ; STRONG, R. W ; CLOUSTON, A. D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c285t-6b83e1e7eb17e3ff6b8d22ff59afa80539bc2e4e0d6d9a07687a5521f4e532f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Chronic Disease</topic><topic>Female</topic><topic>Graft Rejection - pathology</topic><topic>Hepatitis - pathology</topic><topic>Humans</topic><topic>Infant</topic><topic>Liver - pathology</topic><topic>Liver Circulation</topic><topic>Liver Transplantation - pathology</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Necrosis</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Thrombosis - pathology</topic><topic>Transplantation, Homologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>NAKAZAWA, Y</creatorcontrib><creatorcontrib>WALKER, N. I</creatorcontrib><creatorcontrib>KERLIN, P</creatorcontrib><creatorcontrib>STEADMAN, C</creatorcontrib><creatorcontrib>LYNCH, S. V</creatorcontrib><creatorcontrib>STRONG, R. W</creatorcontrib><creatorcontrib>CLOUSTON, A. D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>NAKAZAWA, Y</au><au>WALKER, N. I</au><au>KERLIN, P</au><au>STEADMAN, C</au><au>LYNCH, S. V</au><au>STRONG, R. W</au><au>CLOUSTON, A. D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinicopathological analysis of liver allograft biopsies with late centrilobular necrosis : A comparative study in 54 patients</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2000-04-27</date><risdate>2000</risdate><volume>69</volume><issue>8</issue><spage>1599</spage><epage>1608</epage><pages>1599-1608</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><coden>TRPLAU</coden><abstract>Centrilobular necrosis (CLN) in liver allografts can be a difficult lesion to interpret histologically. Although long recognized in association with developing chronic rejection, recent studies have described the lesion in association with a number of other disease processes. To clarify the histologic features that could allow a specific diagnosis to be made and to determine the outcome in different diagnostic groups, we assessed biopsies from 54 patients with CLN.
Biopsies were classified as CLN with acute cellular rejection (ACR), CLN with hepatitis, CLN with developing chronic rejection (CR), and CLN of other etiology. Histologic features were assessed and then compared between groups, and clinical outcomes were noted.
Discriminating features for the different groups were as follows: CLN and ACR showed bile duct injury, endothelialitis, and acinar congestion. CLN and CR showed severe bile duct injury, bile duct loss, or centrilobular swelling. CLN and hepatitis was often a diagnosis of exclusion, although interface hepatitis was more common in this group. Cases of autoimmune hepatitis usually demonstrated plasma cell predominance in the portal and acinar inflammatory infiltrate. Significantly, there was considerable overlap in the histologic features between the groups, accounting for the diagnostic difficulty. Patients in whom the CLN was associated with CR or vascular complications generally required retransplantation or died, but in the groups with ACR and hepatitis, the outcome was more favorable.
With regard to most liver allograft biopsies showing late CLN, it is possible to make a specific diagnosis despite overlapping histologic features; this allows specific therapy to be instituted. Ultimately this is likely to contribute to improved graft survival.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>10836369</pmid><doi>10.1097/00007890-200004270-00014</doi><tpages>10</tpages></addata></record> |
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subjects | Acute Disease Adolescent Adult Biological and medical sciences Biopsy Child Child, Preschool Chronic Disease Female Graft Rejection - pathology Hepatitis - pathology Humans Infant Liver - pathology Liver Circulation Liver Transplantation - pathology Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Middle Aged Necrosis Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Thrombosis - pathology Transplantation, Homologous |
title | Clinicopathological analysis of liver allograft biopsies with late centrilobular necrosis : A comparative study in 54 patients |
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