Although the morphological features of hepatitis C virus(HCV)recurrence after orthotopic liver transplantation(OLT)have been well established in the last decades,the differential diagnosis still represents a challenge...Although the morphological features of hepatitis C virus(HCV)recurrence after orthotopic liver transplantation(OLT)have been well established in the last decades,the differential diagnosis still represents a challenge for the pathologist,especially early recurrent hepatitis C vs mild acute cellular rejection.The present review focuses on the role of the pathologist and the pathology laboratory in the management of recipients with recurrent hepatitis C,the usefulness of early and late post-OLT liver biopsies,and the potential role of ancillary techniques(immunohistochemistry and reverse transcription-polymerase chain reaction,RT-PCR).The English literature on the topic is reviewed,focusing on the histopathology,the immunohistochemistry and the use of RT-PCR on HCV-positive post-OLT biopsies.The different histopathological illustrations of early and chronic recurrent hepatitis C are presented,with special focus on the main differential diagnoses and those features with prognostic relevance(cholestasis above all).The usefulness of ancillary techniques are discussed,especially HCV RNA quantitation by RT-PCR.Finally,the usefulness of long-term protocol biopsies is addressed:their usefulness for the study of allograft disease progression is clear,but their meaning in the long term is still debated.The significance of plasma cell infiltrate in HCV-positive allografts,the prognostic weight of graft steatosis,and the impact of donor age in recurrent hepatitis C also represent additional open issues.展开更多
AIM: To define the histopathological features predictive of post-transplant hepatocellular carcinoma(HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification.METHODS: We retr...AIM: To define the histopathological features predictive of post-transplant hepatocellular carcinoma(HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification.METHODS: We retrospectively reviewed the specimens of all suspicious nodules(total 275) from 101 consecutive liver transplant recipients which came to our Pathology Unit over a 6-year period. All nodules were sampled and analyzed, and follow-up data were collected. We finally considered 11 histological variables for each patient: total number of nodules, number of viable nodules, size of the major nodule, size of the major viable nodule, occurrence of microscopic vascular invasion, maximum Edmondson's grade, clear cell/sarcomatous changes, and the residual neoplastic volume. Survival data were computed by means of the Kaplan-Meier procedure and analyzed by means of the Cox proportional hazards model. The multivariate linear regression and a k-means cluster analysis were also used in order to compute the standardized histological score.RESULTS: The total number of nodules, the residual neoplastic volume(the total volume of all evaluated nodules minus the necrotic portion) and the microvascular invasion entered the Cox multivariate hazard model with HCC recurrence as dependent variable. The histological score was therefore computed and a cluster analysis sorted recipients into 3 risk groups, with 3.3%, 18.5% and 53.8% respectively of tumor recurrence rates and 1.6%, 11.1% and 38.5% of tumor-related mortality respectively at the end of follow-up.CONCLUSION: The histological score allows a reliable stratification of HCC recurrence risk, especially in those recipients found out to be beyond the Milan criteria after orthotopic liver transplantation(OLT).展开更多
In the two past decades, a number of communications, case-control studies, and retrospective reports have appeared in the literature with concerns about the development of a complex set of clinical, laboratory and his...In the two past decades, a number of communications, case-control studies, and retrospective reports have appeared in the literature with concerns about the development of a complex set of clinical, laboratory and histological characteristics of a liver graft dysfunction that is compatible with autoimmune hepatitis. The de novo prefix was added to distinguish this entity from a pre-transplant primary autoimmune hepatitis, but the globally accepted criteria for the diagnosis of autoimmune hepatitis have been adopted in the diagnostic algorithm. Indeed, de novo autoimmune hepatitis is characterized by the typical liver necroinflammation that is rich in plasma cells, the presence of interface hepatitis and the consequent laboratory findings of elevations in liver enzymes, increases in serum gamma globulin and the appearance of nonorgan specific auto-antibodies. Still, the overall features of de novo autoimmune hepatitis appear not to be attributable to a univocal patho-physiological pathway because they can develop in the patients who have undergone liver transplantation due to different etiologies. Specifically, in subjects with hepatitis C virus recurrence, an interferon-containing antiviral treatment has been indicated as a potential inception of immune system derangement. Herein, we attempt to review the currently available knowledge about de novo liver autoimmunity and its clinical management.展开更多
文摘Although the morphological features of hepatitis C virus(HCV)recurrence after orthotopic liver transplantation(OLT)have been well established in the last decades,the differential diagnosis still represents a challenge for the pathologist,especially early recurrent hepatitis C vs mild acute cellular rejection.The present review focuses on the role of the pathologist and the pathology laboratory in the management of recipients with recurrent hepatitis C,the usefulness of early and late post-OLT liver biopsies,and the potential role of ancillary techniques(immunohistochemistry and reverse transcription-polymerase chain reaction,RT-PCR).The English literature on the topic is reviewed,focusing on the histopathology,the immunohistochemistry and the use of RT-PCR on HCV-positive post-OLT biopsies.The different histopathological illustrations of early and chronic recurrent hepatitis C are presented,with special focus on the main differential diagnoses and those features with prognostic relevance(cholestasis above all).The usefulness of ancillary techniques are discussed,especially HCV RNA quantitation by RT-PCR.Finally,the usefulness of long-term protocol biopsies is addressed:their usefulness for the study of allograft disease progression is clear,but their meaning in the long term is still debated.The significance of plasma cell infiltrate in HCV-positive allografts,the prognostic weight of graft steatosis,and the impact of donor age in recurrent hepatitis C also represent additional open issues.
文摘AIM: To define the histopathological features predictive of post-transplant hepatocellular carcinoma(HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification.METHODS: We retrospectively reviewed the specimens of all suspicious nodules(total 275) from 101 consecutive liver transplant recipients which came to our Pathology Unit over a 6-year period. All nodules were sampled and analyzed, and follow-up data were collected. We finally considered 11 histological variables for each patient: total number of nodules, number of viable nodules, size of the major nodule, size of the major viable nodule, occurrence of microscopic vascular invasion, maximum Edmondson's grade, clear cell/sarcomatous changes, and the residual neoplastic volume. Survival data were computed by means of the Kaplan-Meier procedure and analyzed by means of the Cox proportional hazards model. The multivariate linear regression and a k-means cluster analysis were also used in order to compute the standardized histological score.RESULTS: The total number of nodules, the residual neoplastic volume(the total volume of all evaluated nodules minus the necrotic portion) and the microvascular invasion entered the Cox multivariate hazard model with HCC recurrence as dependent variable. The histological score was therefore computed and a cluster analysis sorted recipients into 3 risk groups, with 3.3%, 18.5% and 53.8% respectively of tumor recurrence rates and 1.6%, 11.1% and 38.5% of tumor-related mortality respectively at the end of follow-up.CONCLUSION: The histological score allows a reliable stratification of HCC recurrence risk, especially in those recipients found out to be beyond the Milan criteria after orthotopic liver transplantation(OLT).
文摘In the two past decades, a number of communications, case-control studies, and retrospective reports have appeared in the literature with concerns about the development of a complex set of clinical, laboratory and histological characteristics of a liver graft dysfunction that is compatible with autoimmune hepatitis. The de novo prefix was added to distinguish this entity from a pre-transplant primary autoimmune hepatitis, but the globally accepted criteria for the diagnosis of autoimmune hepatitis have been adopted in the diagnostic algorithm. Indeed, de novo autoimmune hepatitis is characterized by the typical liver necroinflammation that is rich in plasma cells, the presence of interface hepatitis and the consequent laboratory findings of elevations in liver enzymes, increases in serum gamma globulin and the appearance of nonorgan specific auto-antibodies. Still, the overall features of de novo autoimmune hepatitis appear not to be attributable to a univocal patho-physiological pathway because they can develop in the patients who have undergone liver transplantation due to different etiologies. Specifically, in subjects with hepatitis C virus recurrence, an interferon-containing antiviral treatment has been indicated as a potential inception of immune system derangement. Herein, we attempt to review the currently available knowledge about de novo liver autoimmunity and its clinical management.
