Transcript HISTOPATHOLOGY OF HEPATITIS C VIRUS REINFECTION AFTER

Banff 2001
Liver Group Discussions
Banff 2001 - Liver Group Discussions
1.
Rejection
2.Centrilobular (zone 3) inflammatory lesions
3.Changes in late post-transplant biopsies
Banff Schema for Grading and Staging
LiverAllograft Rejection
Banff Meeting
Consensus Agreement
1995
Banff Schema for grading acute liver allograft
rejection
1997
Problems with diagnosis of chronic rejection
1999
Banff Schema for staging chronic liver allograft
rejection
2001
No further modifications required
Banff 2001 presentation
M Sebagh
Test of 1999 Banff Schema for chronic rejection
Centrilobular Inflammatory Lesions
Definition
Inflammatory lesions involving
hepatic venules and
surrounding liver parenchyma
Problems
Determining aetiology
Terminology
Centrilobular Inflammatory Lesions
Aetiology (1) - Early post-transplant
Most cases related to rejection
- co-exist with typical portal inflammatory changes
- hepatic venular endothelial inflammation often prominent
- prognostic importance
Banff 2001 presentations
Animal model (AJ Demetris)
- dendritic cells in walls of hepatic venules likely to be important in
pathogenesis
Clinical Studies (A Krasinska)
- importance in paediatric allograft recipients
Centrilobular Inflammatory Lesions
Aetiology (2) - Late post-transplant
Diagnosis less straightforward
- typical portal inflammatory changes may not be present
- hepatic venular endothelial inflammation rarely prominent
- other possible causes
recurrent disease (viral or autoimmune)
acquired “autoimmune” hepatitis
drug toxicity
cause unknown
Banff 2001 presentations - causes discussed
Y Nakazawa & A Clouston
- acquired “autoimmune” hepatitis
D Neil
- drug toxicity
S Hubscher
- recurrent HCV infection
Centrilobular Inflammatory Lesions
Terminology
Current Term
“Central venulitis”
BUT
(1) Many cases lack hepatic venular endothelial
inflammation
(2)
“Central venulitis” implies a rejection-related process
Alternative Term
“Central perivenulitis”
Assessment of Late Post-Transplant Biopsies
Disease Recurrence
General Aspects
Most diseases leading to transplantation in adults have the
potential to recur.
Clinical impact of disease recurrence varies widely.
Diagnostic Problems
Similarity between recurrent disease and other graft complications
e.g
HCV and acute rejection
PBC and chronic rejection
PSC and ischaemic cholangitis
Disease modification by immunosuppression
e.g.
Atypical patterns in recurrent HBV & HCV
Assessment of Late Post-Transplant Biopsies
Disease Recurrence
Banff 2001 Presentations
C Bellamy
Alcoholic liver disease
S Hubscher
Hepatitis C
U Khettry
Primary biliary cirrhosis
M Reynes
Evaluation of 10 year post-transplant biopsies
Assessment of Late Post-Transplant Biopsies
Other Findings - Unexplained Chronic Allograft Hepatitis
Histological Features
Predominantly portal inflammation, variable interface hepatitis
Parenchymal inflammation commonly present
(may include zone 3 lesions with confluent necrosis)
Possible causes
Viral Infection (HBV, HCV)recurrent or acquired
Autoimmune liver disease
recurrent or acquired
Drug toxicity
Rejection
Banff 2001 presentations
J Hart, A Sonzogni
- de novo “autoimmune” hepatitis in paediatric
allograft recipients
Banff 2001 - Liver Group Discussions
Summary and Further Plans
1. Rejection
no modification to existing Banff Schema needed
2. Centrilobular inflammatory lesions
(“Central Perivenulitis”)
consensus document with guidelines for histological
assessment and differential diagnosis
3. Changes in late post-transplant biopsies
(“Chronic Allograft Hepatitis”)
consensus document with guidelines for histological
assessment and differential diagnosis of unexplained chronic
hepatitis