Banff 2001Liver Group Discussions

1. Rejection

2.Centrilobular (zone 3) inflammatory lesions

3.Changes in late post-transplant biopsies

Banff 2001 - Liver Group Discussions

Banff Meeting Consensus Agreement1995 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

Banff Schema for Grading and Staging LiverAllograft Rejection

Definition Inflammatory lesions involving hepatic venules and surrounding liver parenchyma

Problems Determining aetiologyTerminology

Centrilobular Inflammatory Lesions

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

Centrilobular Inflammatory Lesions

Aetiology (1) - Early 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” hepatitisdrug toxicitycause unknown

Banff 2001 presentations - causes discussed

Y Nakazawa & A Clouston - acquired “autoimmune” hepatitis

D Neil - drug toxicity

S Hubscher - recurrent HCV infection

Centrilobular Inflammatory Lesions

Aetiology (2) - Late post-transplant

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”

Centrilobular Inflammatory LesionsTerminology

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 complicationse.g HCV and acute rejection

PBC and chronic rejectionPSC and ischaemic cholangitis

Disease modification by immunosuppressione.g. Atypical patterns in recurrent HBV & HCV

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

Assessment of Late Post-Transplant BiopsiesDisease Recurrence

Histological FeaturesPredominantly portal inflammation, variable interface hepatitisParenchymal inflammation commonly present

(may include zone 3 lesions with confluent necrosis)

Possible causesViral Infection (HBV, HCV) recurrent or acquiredAutoimmune liver disease recurrent or acquiredDrug toxicityRejection

Banff 2001 presentations

J Hart, A Sonzogni - de novo “autoimmune” hepatitis in paediatric allograft recipients

Assessment of Late Post-Transplant BiopsiesOther Findings - Unexplained Chronic Allograft Hepatitis

1. Rejectionno 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

Banff 2001 - Liver Group DiscussionsSummary and Further Plans