Abstract
Serial graft biopsies (n = 78) from 12 liver transplant recipients (followed clinically up to 47 months) were studied with the use of histology, histochemistry, immunostaining, and electron microscopy. Planned-protocol needle biopsy specimens were taken from the graft before removal from the donor, 1 hour after transplantation, on the eighth day, and at yearly intervals. Nonprotocol biopsies were taken when deterioration of the clinical condition made a decision on changes in the regimen necessary. The protocol biopsies provided a baseline for graft condition and diagnostic histopathologic features. In these biopsies signs of hyperacute rejection, chronic rejection, or the recipient's previous liver disease were not observed. Mild acute rejection was regularly present on the eighth day, possibly due to a lag phase in the effect of immunosuppression. The syndromes in the nonprotocol biopsies included "pure" parenchymal cholestasis, reversible acute rejection resembling chronic active hepatitis, viral infection, and acute bacterial cholangitis. Each of these syndromes correlated with a separate histopathologic entity. Therefore, these entities proved to be of diagnostic value. It is concluded that a graft biopsy may substantially add to the pathogenetic interpretation, differential diagnosis, and management of major graft syndromes in orthotopic liver transplant recipients.
Full text
PDF













Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Andres G. A., Ansell I. D., Halgrimson C. G., Hsu K. C., Porter K. A., Starzl T. E., Accinni L., Calne R. Y., Herbertson B. M., Penn I. Immunopathological studies of orthotopic human liver allografts. Lancet. 1972 Feb 5;1(7745):275–280. doi: 10.1016/s0140-6736(72)90288-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Calne R. Y. A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts. Ann Surg. 1976 Nov;184(5):605–609. doi: 10.1097/00000658-197611000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Calne R. Y., Williams R. Orthotopic liver transplantation: the first 60 patients. Br Med J. 1977 Feb 19;1(6059):471–476. doi: 10.1136/bmj.1.6059.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Corson J. M. The pathologist and the kidney transplant. Pathol Annu. 1972;7:251–292. [PubMed] [Google Scholar]
- Eggink H. F., Houthoff H. J., Huitema S., Gips C. H., Poppema S. Cellular and humoral immune reactions in chronic active liver disease. I. Lymphocyte subsets in liver biopsies of patients with untreated idiopathic autoimmune hepatitis, chronic active hepatitis B and primary biliary cirrhosis. Clin Exp Immunol. 1982 Oct;50(1):17–24. [PMC free article] [PubMed] [Google Scholar]
- Emeis J. J., Lindeman J., Nieuwenhuizen W. Immunoenzyme histochemical localization of fibrin degradation products in tissues. Am J Pathol. 1981 Jun;103(3):337–344. [PMC free article] [PubMed] [Google Scholar]
- Fennell R. H., Jr, Roddy H. J. Liver transplantation: the pathologist's perspective. Pathol Annu. 1979;14(Pt 2):155–182. [PubMed] [Google Scholar]
- Gips C. H., Krom R. A., Houthoff H. J., Schuur K. H. Indicatiestelling en procedure bij het verwijzen van patiënten voor levertransplantatie. Ned Tijdschr Geneeskd. 1981 May 30;125(22):875–878. [PubMed] [Google Scholar]
- Gips C. H., Krom R. A., de Groot E. H. Het lot van 30 patiënten voor wie in de jaren 1977 t.m. 1979 een levertransplantatie is overwogen, die bij 7 van hen ook is uitgevoerd. Ned Tijdschr Geneeskd. 1981 May 30;125(22):868–875. [PubMed] [Google Scholar]
- Houthoff H. J., Niermeijer P., Gips C. H., Arends A., Hofstee N. Hepatic morphologic findings and viral antigens in acute hepatitis B. A longitudinal study. Virchows Arch A Pathol Anat Histol. 1980;389(2):153–166. doi: 10.1007/BF00439483. [DOI] [PubMed] [Google Scholar]
- Hume D. M., Wolf J. S., Lee H. M., Abouna G. Liver transplantation. Transplant Proc. 1972 Dec;4(4):781–784. [PubMed] [Google Scholar]
- Krom R. A., Gips C. H., Kootstra G., Newton D. Zes levertransplantaties te Groningen verricht. Ned Tijdschr Geneeskd. 1981 May 30;125(22):878–885. [PubMed] [Google Scholar]
- Macdougall B. R., Johnson P. J., Williams R., Strunin L., Macmaster P., Calne R. Y., Bronkhorst F. B., Katchaki J. N., Brandt K. H., Houthoff H. J. Liver transplantation in a 27-year-old female with familial HBsAg-positive hepatocellular carcinoma. Neth J Med. 1978;21(3):101–116. [PubMed] [Google Scholar]
- Roddy H., Putnam C. W., Fennell R. H., Jr Pathology of liver transplantation. Transplantation. 1976 Dec;22(6):625–630. doi: 10.1097/00007890-197612000-00013. [DOI] [PubMed] [Google Scholar]
- STARZL T. E., MARCHIORO T. L., VONKAULLA K. N., HERMANN G., BRITTAIN R. S., WADDELL W. R. HOMOTRANSPLANTATION OF THE LIVER IN HUMANS. Surg Gynecol Obstet. 1963 Dec;117:659–676. [PMC free article] [PubMed] [Google Scholar]
- Starzl T. E., Koep L. J., Halgrimson C. G., Hood J., Schroter G. P., Porter K. A., Weil R., 3rd Fifteen years of clinical liver transplantation. Gastroenterology. 1979 Aug;77(2):375–388. [PMC free article] [PubMed] [Google Scholar]
- Starzl T. E., Porter K. A., Putnam C. W., Schroter G. P., Halgrimson C. G., Weil R., 3rd, Hoelscher M., Reid H. A. Orthotopic liver transplantation in ninety-three patients. Surg Gynecol Obstet. 1976 Apr;142(4):487–505. [PMC free article] [PubMed] [Google Scholar]
- Thomas H. C., Vaez-Zadeh F. A homeostatic mechanism for the removal of antigen from the portal circulation. Immunology. 1974 Feb;26(2):375–382. [PMC free article] [PubMed] [Google Scholar]
- Ware A. J., Luby J. P., Eigenbrodt E. H., Long D. L., Hull A. R. Spectrum of liver disease in renal transplant recipients. Gastroenterology. 1975 Apr;68(4 Pt 1):755–764. [PubMed] [Google Scholar]
- Williams R., Smith M., Shilkin K. B., Herbertson B., Joysey V., Calne R. Y. Liver transplantation in man: the frequency of rejection, biliary tract complications, and recurrence of malignancy based on an analysis of 26 cases. Gastroenterology. 1973 May;64(5):1026–1048. [PubMed] [Google Scholar]
- Yamada G., Feinberg L. E., Nakane P. K. Hepatitis B. Cytologic localization of virus antigens and the role of the immune response. Hum Pathol. 1978 Jan;9(1):93–109. doi: 10.1016/s0046-8177(78)80011-2. [DOI] [PubMed] [Google Scholar]
- van der Waaij D., Berghuis-de Vries J. M. Selective elimination of Enterobacteriaceae species from the digestive tract in mice and monkeys. J Hyg (Lond) 1974 Apr;72(2):205–211. doi: 10.1017/s002217240002341x. [DOI] [PMC free article] [PubMed] [Google Scholar]





