Chronic Rejection


Portal Tract Showing Paucity of Bile Ducts
Portal tract in a case of chronic ductopenic rejection contains a hepatic artery image and portal vein image but no interlobular bile duct.



image
Intimal Foam Cell Arteriopathy
Medium-sized muscular artery shows intimal foam cell arteriopathy image in chronic rejection.

image
Hepatocellular Necrosis in Early Chronic Rejection
Centrilobular hepatocellular necrosis image may be an early sign of impending chronic rejection.

image
PAS-D Highlights Paucity of Bile Ducts
PAS stain with diastase digestion in a case of chronic rejection shows the presence of hepatic arterioles image and portal vein image but no interlobular bile ducts.



TERMINOLOGY


Abbreviations




• Chronic rejection (CR)


Synonyms




• Ductopenic rejection


Definitions




• Presents in 2 forms
image Obliterative (foam cell) arteriopathy

– Only seen in large- and medium-sized arteries

image Bile duct loss

– Most common finding in allograft biopsy


ETIOLOGY/PATHOGENESIS


Immune-Mediated Damage to Allograft




• May evolve from severe or repeated acute cellular rejection and result in potentially irreversible damage to interlobular bile ducts &/or endothelium of veins and arteries

• Occurs later than acute cellular rejection


CLINICAL ISSUES


Presentation




• Progressive jaundice and elevated cholestatic enzymes


Treatment




• Early chronic rejection may respond to potent immunosuppressants such as tacrolimus, OKT3, mycophenolate, or rapamycin

Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. Neonatal Hemochromatosis
  2. Hepatoportal Sclerosis
  3. Drug-Related Acute Hepatitis
  4. Biliary Atresia

Stay updated, free articles. Join our Telegram channel
Tags:
Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Chronic Rejection

Full access? Get Clinical Tree
Get Clinical Tree app for offline access