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Liver and intrahepatic bile ducts-nontumor


Chronic graft rejection

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 22 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.


● Usually irreversible injury of hepatic allografts, likely secondary to ischemic damage to hepatocytes or direct immunologic damage to bile ducts with total loss (vanishing bile duct syndrome)
● May have insidious onset with no acute component

Micro description

Vanishing bile duct syndrome: loss of intrahepatic bile ducts, minimal portal inflammation
Obliterative endarteritis: occlusion by subintimal fibrosis and foam cell change in large and medium sized hilar hepatic arteries and portal vein and distal branches near hilum
● Also associated ischemic changes of centrilobular ballooning degeneration, pericellular fibrosis and possibly cirrhosis
● Changes more variable in portal vein
● Pathognomonic arterial changes are rarely present in needle biopsies

Micro images

Portal vein with foam cell change and luminal obliteration

Differential diagnosis

● Recurrent primary sclerosing cholangitis (Liver Transpl 2006;12:S68)
● Recurrent hepatitis C (Liver Transpl Surg 1997;3:398, Hum Pathol 2009;40:92, Adv Anat Pathol. 2009;16:97)

Additional references

Arch Pathol Lab Med 2004;128:64 (portal vein changes), Am J Surg Pathol 1999;23:1328 (reversibility), J Clin Pathol 2010;63:47 , Semin Diagn Pathol 2006;23:170, Transpl Int 2010;23:971

End of Liver and intrahepatic bile ducts-nontumor > Transplantation > Hyperacute graft rejection

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