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Banff 2001 Liver Group Discussions

Banff 2001 Liver Group Discussions. Banff 2001 - Liver Group Discussions. 1. Rejection 2. Centrilobular (zone 3) inflammatory lesions 3. Changes in late post-transplant biopsies. Banff Schema for Grading and Staging LiverAllograft Rejection. Banff Meeting Consensus Agreement

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Banff 2001 Liver Group Discussions

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  1. Banff 2001Liver Group Discussions

  2. Banff 2001 - Liver Group Discussions 1. Rejection 2. Centrilobular (zone 3) inflammatory lesions 3. Changes in late post-transplant biopsies

  3. Banff Schema for Grading and Staging LiverAllograft Rejection Banff Meeting Consensus Agreement 1995 Banff Schema for grading acute liver allograft rejection 1997 Problems with diagnosis of chronic rejection 1999 Banff Schema for staging chronic liver allograft rejection 2001 No further modifications required Banff 2001 presentation M Sebagh Test of 1999 Banff Schema for chronic rejection

  4. Centrilobular Inflammatory Lesions Definition Inflammatory lesions involving hepatic venules and surrounding liver parenchyma Problems Determining aetiology Terminology

  5. Centrilobular Inflammatory LesionsAetiology (1) - Early post-transplant Most cases related to rejection - co-exist with typical portal inflammatory changes - hepatic venular endothelial inflammation often prominent - prognostic importance Banff 2001 presentations Animal model (AJ Demetris) - dendritic cells in walls of hepatic venules likely to be important in pathogenesis Clinical Studies (A Krasinska) - importance in paediatric allograft recipients

  6. Centrilobular Inflammatory LesionsAetiology (2) - Late post-transplant Diagnosis less straightforward - typical portal inflammatory changes may not be present - hepatic venular endothelial inflammation rarely prominent - other possible causes recurrent disease (viral or autoimmune) acquired “autoimmune” hepatitis drug toxicity cause unknown Banff 2001 presentations - causes discussed Y Nakazawa & A Clouston - acquired “autoimmune” hepatitis D Neil - drug toxicity S Hubscher - recurrent HCV infection

  7. Centrilobular Inflammatory LesionsTerminology Current Term “Central venulitis” BUT (1) Many cases lack hepatic venular endothelial inflammation (2) “Central venulitis”implies a rejection-related process Alternative Term“Central perivenulitis”

  8. Assessment of Late Post-Transplant BiopsiesDisease Recurrence General Aspects Most diseases leading to transplantation in adults have the potential to recur. Clinical impact of disease recurrence varies widely. Diagnostic Problems Similarity between recurrent disease and other graft complications e.g HCV and acute rejection PBC and chronic rejection PSC and ischaemic cholangitis Disease modification by immunosuppression e.g. Atypical patterns in recurrent HBV & HCV

  9. Assessment of Late Post-Transplant BiopsiesDisease Recurrence Banff 2001 Presentations C Bellamy Alcoholic liver disease S Hubscher Hepatitis C U Khettry Primary biliary cirrhosis M Reynes Evaluation of 10 year post-transplant biopsies

  10. Assessment of Late Post-Transplant BiopsiesOther Findings - Unexplained Chronic Allograft Hepatitis Histological Features Predominantly portal inflammation, variable interface hepatitis Parenchymal inflammation commonly present (may include zone 3 lesions with confluent necrosis) Possible causes Viral Infection (HBV, HCV) recurrent or acquired Autoimmune liver disease recurrent or acquired Drug toxicity Rejection Banff 2001 presentations J Hart, A Sonzogni - de novo “autoimmune” hepatitis in paediatric allograft recipients

  11. Banff 2001 - Liver Group DiscussionsSummary and Further Plans 1. Rejection no modification to existing Banff Schema needed 2. Centrilobular inflammatory lesions (“Central Perivenulitis”) consensus document with guidelines for histological assessment and differential diagnosis 3. Changes in late post-transplant biopsies (“Chronic Allograft Hepatitis”) consensus document with guidelines for histological assessment and differential diagnosis of unexplained chronic hepatitis

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