1471 Loss of Canal of Hering, a Feature of Early Chronic Rejection in Liver Allograft Transplantation

Document Type

Conference Proceeding

Publication Date

3-24-2025

Publication Title

Lab Invest

Keywords

adult, allograft, allotransplantation, bile duct injury, cholangiocyte, chronic graft rejection, clinical article, conference abstract, diagnosis, differential diagnosis, electronic medical record, female, hepatic artery, hepatic portal vein, histology, human, liver cell, male, T lymphocyte, therapy

Abstract

Disclosures: Zhengfan Xu: None; Beena Ahsan: None; Brian Theisen: None; Qing Chang: None Background: T-cell mediated chronic rejection (CR), occurring weeks to years post-transplantation, causes damage to bile duct and blood vessel and eventually causes allograft failure. Chronic rejection is categorized into early chronic rejection (ECR) and late chronic rejection (LCR). Differentiating them is clinically important, as ECR is reversible. Interlobular bile duct injury and ductopenia is hallmark feature of CR. Canals of Hering (CoH) are strings of small cholangiocytes located in acinus zone 1 or 2. Because of their more proximal location in bile draining pathway, it is reasonable to assume that loss of CoH (LOH) would be prior to interlobular bile duct injury as an earlier feature of ECR. Design: A search of pathology database from our institution was conducted to select cases that contain “chronic rejection” in final diagnosis including comment section. Slides were reviewed to determine the ECR histological features. The features included bile duct loss in < 50% of all portal tracts, foamy cell change in perihilar hepatic artery branches, perivenular zone 3 hepatocyte dropout and mild perivenular fibrosis or perivenulitis. Meanwhile, CK7 and CK19 stains were evaluated to assess the LOH. Clinical information was collected from electronic medical records. Results: Our cohort contained 31 patients with 13 male and 18 female patients (M:F ratio 1:1.4), ranged from 20 to 73 years with a median of 54.5. Of the 31 patents, ductal paucity (< 50% portal tract loss) was seen in 7 patients, LOH presented in 5 of them. 2 patients showed foamy cell change in the intima of artery, and both demonstrated concurrent LOH. Perivenular hepatocyte drop-out was seen in 8 patients, among which 2 patients showed LOH. Perivenular fibrosis or perivenulitis was seen in 7 patients, among which 3 patients showed LOH. 4 patients demonstrated ductopenia and were diagnosed as chronic rejection. 3 of them showed LOH. In reports of 9 patients, CR was listed as top 3 differential diagnosis. LOH was seen in 5 of them. See Table. [Formula presented] [Formula presented] Conclusions: LOH evaluated by CK19 and CK7 stains has a strong correlation with ductopaucity and arterial foamy cell change, features of ECR, as well as ductopenia, features of LCR. In contrast, correlation with perivenular hepatocyte drop out and perivenulitis or fibrosis is weak. In summary, LOH is probably one of the earliest features of chronic rejection in liver allograft transplantation.

Volume

105

Issue

3

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