Indian Journal of Pathology and Microbiology
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ORIGINAL ARTICLE
Year : 2022  |  Volume : 65  |  Issue : 4  |  Page : 802-808

A comparative histological analysis of early and late graft dysfunction in different time zones following living donor liver transplantation


1 Department of Pathology, Institute of Liver and Biliary Sciences, Delhi, India
2 Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, Delhi, India
3 Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
4 Department of Statisics, Institute of Liver and Biliary Sciences, Delhi, India
5 Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, Delhi, India
6 Department of Liver Transplantation and HPB Surgery, Institute of Liver and Biliary Sciences, Delhi, India

Correspondence Address:
Archana Rastogi
Professor (Pathology), Institute of Liver and Biliary Sciences (ILBS), D-1, Vasant Kunj, New Delhi - 110 070
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_408_21

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Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking. Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series. Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3–6), 3 and 4-late (6–12 and > 12) months] and were assessed for sixteen histological parameters. Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001). Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.


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