PATHOLOGICAL DIAGNOSIS OF LIVER GRAFT REJECTION_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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The Second Affiliated Hospital, Shantou University of Medical College, Shantou 515041;

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Liver transplantation Rejection Pathological diagnosis

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【Abstract】Objective To evaluate the pathological diagnosis of liver allograft rejection. Methods Literatures about diagnosis of liver transplantation rejection in recent ten years were reviewed.Results Humoral rejection was rare. The main features were graft blood vessel thrombosis and liver damage and necrosis about some days or one week after transplantation. The humoral rejection of liver graft occurred later than that of kidney and heart transplantation. The diagnosis of acute liver graft rejection was based on Banff Schema. During chronic rejection intrahepatic bile ducts among hepatic lobules in portal area disappeared, and inflammation, fibrosis and stricture of hepatic arteries and veins were found, but the morbidity was less than that of kidney， heart, lung and pancreas grafting. Conclusion Banff standard is the most important base of diagnosing liver graft rejection.

Citation： SHEN Wenl,SHEN Kai,FAN Liming.. PATHOLOGICAL DIAGNOSIS OF LIVER GRAFT REJECTION. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2001, 8(6): 429-432. doi: Copy

1.	Bells SH,Beringer KC,Detre K.Trends in liver transplantation in the united states 1993. In: Terasaki PI, Cecka JM, eds. Clinical Transplants 〔M〕. Los Angeles: UCLA Tissue Typing Laboratiory, 1994∶19-36.
2.	Demetris AJ, Belle SH, Hart J, et al. Reliability and predictive value of the national institute of diabetes and digestive and kidney diseases liver transplantation database nomenclature and grading system for cellular rejection of liver allografts 〔Ｊ〕. Hepatology, 1995; 21(2)∶408.
3.	International Working Party. Terminology of hepatic allograft rejection 〔Ｊ〕 . Hepatology, 1995; 22(2)∶648.
4.	Demetris AJ, Jaffe R, Tzakis A, et al. Antibodymediated rejection of human orthotopic liver allografts: a study of liver transplantation across ABO blood group barriers 〔Ｊ〕. Am J Pathol, 1988; 132(3)∶489.
5.	Markin RS, Wisecarver JL, Radio SJ. Hepatic allograft pathology. In: Kolbeck PC, Markin RS, Mcmanus BM. Transplant pathology 〔M〕 . lst ed. ASCP Press，1995∶ 244-249.
6.	Kobayashi M, Yagihashi A, Manez R, et al. Posttransplant donorspecific Tlymphocytotoxic antibody in liver transplant patients with a positive crossmatch 〔Ｊ〕. Transplant Proc, 1992; 24(6)∶2510.
7.	Chauhan B, Phelan DL, Marsh JW, et al. Characterization of antiidiotypic antibodies to donor HLA that develop after liver transplantation 〔Ｊ〕. Transplantation, 1993; 56(2)∶443.
8.	Demetris AJ, Nakamura K, Yagihashi A, et al. A clinicopathologic study of human liver allograft recipients harboring preformed IgG lymphocytotoxic antiboies 〔Ｊ〕. Hepatology, 1992; 16(3)∶ 671.
9.	Fisher LR, Henley KS, Lucey MR. Acute cellular rejection after liver transplantation: variability, morbidity, and mortality 〔Ｊ〕. Liver Transpl Surg, 1995; 1(1)∶10.
10.	Ludwig J . Terminology of hepatic allograft rejection(glossary) 〔Ｊ〕. Semin Liver Dis, 1992; 12(1)∶89.
11.	Snover DC, Freese DK, Sharp HL, et al. Liver rejection: an analysis of the use of biopsy in determining outcome of rejection 〔Ｊ〕. Am J Surg Pathol, 1987; 11(1)∶1.
12.	Kemnitz J, Ringe B, Cohnert TR, et al. Bile duct injury as part of diagnostic criteria for liver allograft rejection 〔Ｊ〕. Hum Pathol, 1988; 20(2)∶132.
13.	Datta Gupts S, Hudson M, Burroughs AK, et al. Grading of cellular rejection after orthotopic liver transplantation 〔Ｊ〕. Hepatology, 1995; 21(1)∶46.
14.	Dousset B,Hubscher SG,Padbury RT,et al.Acute liver allograft rejection is treatment always necessary 〔Ｊ〕. Transplantation,1993; 55(3)∶529.
15.	Hubscher S. Diagnosis and grading of liver allograft rejection: a European perspective 〔Ｊ〕. Transplant Proc, 1996; 28(1)∶504.
16.	An International Panel. Banff Schema for grading liver allograft rejection: an international consensus document 〔Ｊ〕. Hepatology, 1997; 25(3)∶ 658.
17.	Ormonde DG, De Boer WB, Kierath A, et al. Banff Schema for grading liver allograft rejection: utility in clinical practice 〔Ｊ〕. Liver Transpl Surg, 1999; 5(4)∶261.
18.	Demetris AJ, Murase N, Lee RG, et al. Chronic rejection. A general overview of histopathology and pathophysiology with emphasis on liver, heart and intestinal allografts 〔Ｊ〕. Ann Transplant, 1997; 2(2)∶ 27.
19.	Van Hoek B, Wiesner RH, Krom RAF, et al. Severe ductopenic rejection following liver transplantation: incidence, time of onset, risk factors, treatment and outcome 〔Ｊ〕. Semin Liver Dis, 1992; 12(1)∶41.
20.	Hart J,Lewin K.Liver allograft pathology 〔Ｊ〕 .Pathology,1994; 3(1)∶207.
21.	Demetris AJ. Spectrum of chronic hepatic allograft rejection and arteriopathy and the controversy of centrilobular necrosis 〔Ｊ〕.Liver Transpl, 2000; 6（1）∶102.
22.	Fennell RH, Vierling JM. Electron microscopy of rejected human liver allografts 〔Ｊ〕. Hepatology, 1985; 5(6)∶1083.
23.	Ludwig J, Wiesner RH, Batts KP, et al. The acute vanishing bile duct syndrome (acute irreversible rejection) after orthotopic liver transplantation 〔Ｊ〕 .Hepatology, 1987; 7(3)∶476.
24.	Demetris AJ, Seaberg EC, Batts KP, et al. Chronic liver allograft rejection. A national institute of diabetes and digestive and kidney diseases interinstitutional study analyzing the reliability of current criteria and proposal of an expanded definition 〔Ｊ〕 . Am J Surg Pathol, 1998; 22(1)∶28.
25.	Blakolmer K, Seaberg EC, Batts KP, et al. Analysis of the reversibility of chronic liver allograft rejection implications for a staging schema 〔Ｊ〕.Am J Surg Pathol, 1999; 23(11)∶1328.
26.	An International Panel. Update of the international Banff Schema for liver allograft rejection: working recommendations for the histopathologic staging and reporting of chronic rejection 〔Ｊ〕. Hepatology, 2000; 31(3)∶792.

1. Bells SH,Beringer KC,Detre K.Trends in liver transplantation in the united states 1993. In: Terasaki PI, Cecka JM, eds. Clinical Transplants 〔M〕. Los Angeles: UCLA Tissue Typing Laboratiory, 1994∶19-36.
2. Demetris AJ, Belle SH, Hart J, et al. Reliability and predictive value of the national institute of diabetes and digestive and kidney diseases liver transplantation database nomenclature and grading system for cellular rejection of liver allografts 〔Ｊ〕. Hepatology, 1995; 21(2)∶408.
3. International Working Party. Terminology of hepatic allograft rejection 〔Ｊ〕 . Hepatology, 1995; 22(2)∶648.
4. Demetris AJ, Jaffe R, Tzakis A, et al. Antibodymediated rejection of human orthotopic liver allografts: a study of liver transplantation across ABO blood group barriers 〔Ｊ〕. Am J Pathol, 1988; 132(3)∶489.
5. Markin RS, Wisecarver JL, Radio SJ. Hepatic allograft pathology. In: Kolbeck PC, Markin RS, Mcmanus BM. Transplant pathology 〔M〕 . lst ed. ASCP Press，1995∶ 244-249.
6. Kobayashi M, Yagihashi A, Manez R, et al. Posttransplant donorspecific Tlymphocytotoxic antibody in liver transplant patients with a positive crossmatch 〔Ｊ〕. Transplant Proc, 1992; 24(6)∶2510.
7. Chauhan B, Phelan DL, Marsh JW, et al. Characterization of antiidiotypic antibodies to donor HLA that develop after liver transplantation 〔Ｊ〕. Transplantation, 1993; 56(2)∶443.
8. Demetris AJ, Nakamura K, Yagihashi A, et al. A clinicopathologic study of human liver allograft recipients harboring preformed IgG lymphocytotoxic antiboies 〔Ｊ〕. Hepatology, 1992; 16(3)∶ 671.
9. Fisher LR, Henley KS, Lucey MR. Acute cellular rejection after liver transplantation: variability, morbidity, and mortality 〔Ｊ〕. Liver Transpl Surg, 1995; 1(1)∶10.
10. Ludwig J . Terminology of hepatic allograft rejection(glossary) 〔Ｊ〕. Semin Liver Dis, 1992; 12(1)∶89.
11. Snover DC, Freese DK, Sharp HL, et al. Liver rejection: an analysis of the use of biopsy in determining outcome of rejection 〔Ｊ〕. Am J Surg Pathol, 1987; 11(1)∶1.
12. Kemnitz J, Ringe B, Cohnert TR, et al. Bile duct injury as part of diagnostic criteria for liver allograft rejection 〔Ｊ〕. Hum Pathol, 1988; 20(2)∶132.
13. Datta Gupts S, Hudson M, Burroughs AK, et al. Grading of cellular rejection after orthotopic liver transplantation 〔Ｊ〕. Hepatology, 1995; 21(1)∶46.
14. Dousset B,Hubscher SG,Padbury RT,et al.Acute liver allograft rejection is treatment always necessary 〔Ｊ〕. Transplantation,1993; 55(3)∶529.
15. Hubscher S. Diagnosis and grading of liver allograft rejection: a European perspective 〔Ｊ〕. Transplant Proc, 1996; 28(1)∶504.
16. An International Panel. Banff Schema for grading liver allograft rejection: an international consensus document 〔Ｊ〕. Hepatology, 1997; 25(3)∶ 658.
17. Ormonde DG, De Boer WB, Kierath A, et al. Banff Schema for grading liver allograft rejection: utility in clinical practice 〔Ｊ〕. Liver Transpl Surg, 1999; 5(4)∶261.
18. Demetris AJ, Murase N, Lee RG, et al. Chronic rejection. A general overview of histopathology and pathophysiology with emphasis on liver, heart and intestinal allografts 〔Ｊ〕. Ann Transplant, 1997; 2(2)∶ 27.
19. Van Hoek B, Wiesner RH, Krom RAF, et al. Severe ductopenic rejection following liver transplantation: incidence, time of onset, risk factors, treatment and outcome 〔Ｊ〕. Semin Liver Dis, 1992; 12(1)∶41.
20. Hart J,Lewin K.Liver allograft pathology 〔Ｊ〕 .Pathology,1994; 3(1)∶207.
21. Demetris AJ. Spectrum of chronic hepatic allograft rejection and arteriopathy and the controversy of centrilobular necrosis 〔Ｊ〕.Liver Transpl, 2000; 6（1）∶102.
22. Fennell RH, Vierling JM. Electron microscopy of rejected human liver allografts 〔Ｊ〕. Hepatology, 1985; 5(6)∶1083.
23. Ludwig J, Wiesner RH, Batts KP, et al. The acute vanishing bile duct syndrome (acute irreversible rejection) after orthotopic liver transplantation 〔Ｊ〕 .Hepatology, 1987; 7(3)∶476.
24. Demetris AJ, Seaberg EC, Batts KP, et al. Chronic liver allograft rejection. A national institute of diabetes and digestive and kidney diseases interinstitutional study analyzing the reliability of current criteria and proposal of an expanded definition 〔Ｊ〕 . Am J Surg Pathol, 1998; 22(1)∶28.
25. Blakolmer K, Seaberg EC, Batts KP, et al. Analysis of the reversibility of chronic liver allograft rejection implications for a staging schema 〔Ｊ〕.Am J Surg Pathol, 1999; 23(11)∶1328.
26. An International Panel. Update of the international Banff Schema for liver allograft rejection: working recommendations for the histopathologic staging and reporting of chronic rejection 〔Ｊ〕. Hepatology, 2000; 31(3)∶792.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

PATHOLOGICAL DIAGNOSIS OF LIVER GRAFT REJECTION

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