The National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database (NIDDK-LTD) proposed terms and grading criteria for rejection in a biopsy from a liver allograft,
Types of rejection:
(1) acute
(2) chronic (with ductopenia)
Criteria for acute rejection - 2 or 3 of the following:
(1) inflammatory infiltrate in portal triads that is mixed but predominantly mononuclear.
(2) bile duct inflammation and/or damage
(3) subendothelial mononuclear cells in the portal and central veins
|
Inflammation in Portal Triads |
Centrilobular Hepatocyte Necrosis or Dropout |
Acute |
|
none |
none |
none (A0) |
|
some, confined to portal triad |
none |
mild (A1) |
|
most or all, may spillover into lobule |
none |
moderate (A2) |
|
most or all, may spillover into lobule |
present, with moderate to severe lobular inflammation |
severe (A3) |
Criteria for chronic rejection:
(1) bile duct loss involving > 50% of ducts (< 50% remain)
|
Bile Duct Loss |
Other findings |
Chronic |
|
none |
none |
none |
|
present |
none |
early or mild (B1) |
|
present |
one present (see below) |
intermediate or moderate (B2) |
|
present |
two or more present |
late or severe (B3) |
Other findings of chronic rejection:
(1) centrilobular cholestasis
(2) perivenular sclerosis
(3) hepatocyte ballooning
(4) centrilobular hepatocyte necrosis and dropout
Specialty: Gastroenterology
ICD-10: ,
