Acute Cellular Rejection

 Enlarged, activated, or blastic T lymphocytes, eosinophils, and other inflammatory cells

• Bile duct damage
image Lymphocytic infiltration and epithelial cell injury affecting interlobular ducts

• Endotheliitis
image Subendothelial venous inflammation with lifting and denudation of endothelial cells

Top Differential Diagnoses

• Recurrent chronic viral hepatitis (hepatitis B or hepatitis C)

• Biliary complications

• Autoimmune hepatitis

• Posttransplant lymphoproliferative disorders

Classic Features of Rejection
This portal tract contains a mixed inflammatory infiltrate with activated lymphocytes, eosinophils, and plasma cells. The bile duct shows lymphocytic cholangitis and epithelial disarray image. The portal venule contains endotheliitis image .

Portal Vein Endotheliitis
Endotheliitis image is present in a portal vein branch, characterized by inflammatory cells undermining the endothelium and lifting it up. The portal tract also contains a mild inflammatory cell infiltrate, and there is mild bile duct damage image .

Bile Duct Damage
Bile duct damage image is seen in a case of acute cellular rejection. The bile duct epithelial cells show nuclear hyperchromasia, pleomorphism, uneven spacing of nuclei, and loss of polarity. The portal tract also contains a mixed inflammatory cell infiltrate.

Endotheliitis and Perivenular Necrosis
Endotheliitis image affects a terminal hepatic vein. There is also perivenular hepatocyte necrosis image in this case of severe acute rejection.



• Acute cellular rejection (ACR)


• Immune-mediated inflammation and injury of liver allograft due to genetic mismatch


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



• Incidence
image Affects ∼ 20-40% of liver allograft recipients

image All liver transplant recipients are susceptible

– More frequent in younger, healthier recipients and with older donors, long cold ischemia time, and immune dysregulation of recipient

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Acute Cellular Rejection

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