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
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Inflammation in Portal Triads
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Centrilobular Hepatocyte Necrosis or Dropout
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Acute
|
|
none
|
none
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none (A0)
|
|
some, confined to portal triad
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none
|
mild (A1)
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|
most or all, may spillover into lobule
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none
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moderate (A2)
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most or all, may spillover into lobule
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present, with moderate to severe lobular inflammation
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severe (A3)
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Criteria for chronic rejection:
(1) bile duct loss involving > 50% of ducts (< 50% remain)
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Bile Duct Loss
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Other findings
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Chronic
|
|
none
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none
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none
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present
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none
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early or mild (B1)
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present
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one present (see below)
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intermediate or moderate (B2)
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|
present
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two or more present
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late or severe (B3)
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Other findings of chronic rejection:
(1) centrilobular cholestasis
(2) perivenular sclerosis
(3) hepatocyte ballooning
(4) centrilobular hepatocyte necrosis and dropout
