Clinicopathological analysis of liver allograft biopsies with late centrilobular necrosis - A comparative study in 54 patients

Background. Centrilobular necrosis (CLN) in liver allografts can be a diffi cult lesion to interpret histologically. Although long recognized in associ ation with developing chronic rejection, recent studies have described the lesion in association with a number of other disease processes. To clarify the histologic features that could allow a specific diagnosis to be made an d to determine the outcome in different diagnostic groups, we assessed biop sies from 54 patients with CLN. Methods. Biopsies were classified as CLN with acute cellular rejection (ACR ), CLN with hepatitis, CLN with developing chronic rejection (CR), and CLN of other etiology. Histologic features were assessed and then compared betw een groups, and clinical outcomes were noted. Results. Discriminating features for the different groups were as follows: CLN and ACR showed bile duct injury, endothelialitis, and acinar congestion . CLN and CR showed severe bile duct injury, bile duct loss, or centrilobul ar swelling. CLN and hepatitis was often a diagnosis of exclusion, although interface hepatitis was more common in this group. Cases of autoimmune hep atitis usually demonstrated plasma cell predominance in the portal and acin ar inflammatory infiltrate. Significantly, there was considerable overlap i n the histologic features between the groups, accounting for the diagnostic difficulty. Patients in whom the CLN was associated with CR or vascular co mplications generally required retransplantation or died, but in the groups with ACR and hepatitis, the outcome was more favorable. Conclusions. With regard to most liver allograft biopsies showing late CLN, it is possible to make a specific diagnosis despite overlapping histologic features; this allows specific therapy to be instituted. Ultimately this i s likely to contribute to improved graft survival.