Enlarged, activated, or blastic T lymphocytes, eosinophils, and other inflammatory cells
•
Bile duct damage
Lymphocytic infiltration and epithelial cell injury affecting interlobular ducts
•
Endotheliitis
Subendothelial venous inflammation with lifting and denudation of endothelial cells
TERMINOLOGY
Abbreviations
•
Acute cellular rejection (ACR)
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
Epidemiology
•
Incidence
Affects ∼ 20-40% of liver allograft recipients
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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