Article Type

Original Study


Objective The aim of the study was to investigate the impact of clinical and histopathological changes in the liver tissue of acute rejection and recurrent hepatitis C patients after liver transplantation and determine whether they could differentiate between them. Background Hepatitis C virus (HCV) is considered the most common cause of chronic liver disease and may require liver transplantation in advanced stages. Liver transplantation is today a well-established procedure for curative treatment of various inherited and acquired liver diseases, and in many conditions it is the only possible therapeutic strategy. Acute rejection and recurrent HCV infection are the major causes of graft failure in liver transplant patients and differentiation between them is necessary because of different treatment strategies. Patients and methods This retrospective study included liver biopsies from 51 post-transplant patients (25 acute rejection and 26 recurrent hepatitis C patients). Post-transplanted liver biopsies were histopathologically evaluated for portal tract inflammation as regards the extent and nature of the infiltrate, bile duct injury, venous injury, interface hepatitis, and lobular inflammation (spotty necrosis and confluent necrosis). Other pathological findings were also addressed. Demographic, laboratory, and histopathological results were subjected to statistical analysis. Results Clinically, high model for end-stage liver disease score (P < 0.01) and high viremia (P < 0.01) were in favor of recurrent hepatitis C compared with acute rejection. Histopathologically, the two groups differed with regard to the extent and nature of the inflammatory infiltrate, whereas dense infiltrate (grade II and III) was in favor of recurrent hepatitis C (P = 0.02). With regard to the nature of infiltrate, the mean number of eosinophils (P < 0.01), neutrophils (P < 0.05), macrophages (P < 0.01), and immunoblasts (P < 0.01) was higher in acute rejection compared with recurrent hepatitis C. Presence of bile duct injury(P = 0.001), vascular injury (P = 0.001), and perivenular necrosis(P = 0.001) was in favor of acute rejection, whereas the presence of interface hepatitis (P = 0.001), fibrosis (P = 0.001), and steatosis (P = 0.001) was in favor of recurrent hepatitis C. Conclusion The current study demonstrated that discrimination between acute rejection and recurrent hepatitis C in the setting of post-liver-transplantation could be possible on the basis of clinical data (the value of model for end-stage liver disease score and the degree of HCV viremia) and several histopathological parameters.