Acute Cellular Rejection
Lisa Yerian, MD
Key Facts
Terminology
Immune-mediated inflammation and injury of liver allograft due to genetic mismatch
Etiology/Pathogenesis
Inflammatory cells in portal tracts and centrilobular, perivenular areas cause damage to biliary epithelium and endothelial cells
Clinical Issues
Often asymptomatic but may present with fever or abdominal pain
Nonspecific elevation of liver function tests
Can occur at any time after transplantation, but most often presents within 1st month
Microscopic Pathology
Mixed portal inflammatory cell infiltrates, bile duct damage, and subendothelial venous inflammation
 H&E section of acute rejection shows a mixed portal inflammatory cell infiltrate composed of activatedappearing lymphocytes, histiocytes, eosinophils, and other inflammatory cells. |
 H&E stain demonstrates endotheliitis  of a portal vein branch and bile duct damage  . The portal tract also contains a mixed inflammatory cell infiltrate. |
TERMINOLOGY
Abbreviations
Acute cellular rejection (ACR)
Synonyms
Acute rejection
Definitions
Immune-mediated inflammation and injury of liver allograft due to genetic mismatch
ETIOLOGY/PATHOGENESIS
Immune-mediated Inflammatory Process
Recipient immune system recognizes donor antigens in liver allograft as foreign
Inflammatory cells in portal tracts and centrilobular, perivenular areas cause damage to biliary epithelium and endothelial cells
CLINICAL ISSUES
