Kj. Allen et al., PROGNOSTIC IMPLICATIONS OF CENTRILOBULAR NECROSIS IN PEDIATRIC LIVER-TRANSPLANT RECIPIENTS, Transplantation, 65(5), 1998, pp. 692-698
Background We have observed centrilobular necrosis (CLN) in several li
ver allograft biopsies in our pediatric liver transplant population, T
he aims of this study were to describe the associated pathologic and c
linical features of post-orthotopic liver transplantation CLN and dete
rmine its prognostic implications, Methods and Results, CLN was identi
fied and characterized in 44 allografts from 40 patients (17 males and
23 females) among our 443 pediatric recipients, Twenty episodes were
associated with cellular rejection, either in the same biopsy (n=15) o
r within the week: prior (n=5), and five were associated with ductopen
ic rejection, Twelve were associated with vascular thrombosis, No clea
r etiology was identified in seven episodes, but two also had cholangi
tis lenta. Of the remaining five biopsies, three showed only centrilob
ular dropout, suggesting a resolution of some previous insult. The out
come of 40 patients following an initial episode of CLN was poor, with
graft failure in 33, chronic poor function in 2, and normal recovery
in only 5 patients, The results of retransplantation for graft failure
due to CLN were equally poor, with 14 deaths, 3 patients with ductope
nic rejection, and only 5 with normal recovery, CLN recurred in four g
rafts, Overall patient outcome was very poor: 25 deaths; 3 ductopenic
rejections; 2 chronic poorly functioning livers; and 10 patients alive
and well. Conclusion, We conclude that CLN in pediatric orthotopic li
ver transplantation recipients is associated with cellular rejection,
ductopenic rejection, or acute vessel thrombosis in the majority cases
, The prognostic implications of CLN are grave, with high rates of gra
ft failure requiring retransplantation and death.