PRIMARY BILIARY-CIRRHOSIS - HISTOLOGICAL EVIDENCE OF DISEASE RECURRENCE AFTER LIVER-TRANSPLANTATION

Histological evidence of primary biliary cirrhosis (PBC) recurring aft er orthotopic liver transplantation (OLT) was looked for in a 'blinded ' study of 353 biopsies from 188 patients, 12-100 months post-transpla nt. Biopsies (172) were obtained from 83 patients transplanted for PBC and 181 biopsies from 105 patients with other liver diseases. Sixteen biopsies from 13 PBC patients (16%) had features suggestive of recurr ent disease. The main diagnostic findings were: mononuclear portal inf lammatory infiltration (n = 16), portal lymphoid aggregates (n = 14), portal epithelioid granulomas (n = 14) and bile duct damage (n = 15). This combination of changes was not seen in any biopsy from the non-PB C group. Additional features supporting a diagnosis of recurrent disea se were ductopenia (n = 7), bile ductular proliferation (n = 7), porta l fibrosis (n = 6) and copper deposition (n = 5). Thirteen biopsies fr om 12 patients were classified as stage I or II histologically. The ot her patient developed progressive damage in three serial biopsies resu lting in an early micronodular cirrhosis, 5 years post-transplant. The se observations provide further evidence that PBC recurs after OLT. Mo re studies are required to determine the natural history and clinical significance of the predominantly early histological changes documente d so far.