Early vs. Late Liver Allograft T-Cell Mediated Rejection: A Banff Allograft Pathology Update
Claudia Mescoli et al
Read the full manuscript on SSRN
Abstract
The often smouldering accumulation of alloimmune damage after the initial post-transplant months, categorised as late-TCMR, is difficult to sensitively recognise and monitor because: a) liver injury tests can be insensitive and nonspecific, b) lack of protocol liver biopsy practice delays detection until graft dysfunction manifests and c) late rejection does not usually resemble early-TCMR histologically; differences in tempo and pathogenesis lead to distinct clinical and histologic manifestations. Late- compared with early-TCMR is characterized by more prevalent interface and perivenular inflammatory activity, a lymphocyte-predominant infiltrate and fibrosis, with less conspicuous portal, duct-centered and subendothelial venular inflammation. The traditional Banff RAI scheme that works consistently well to diagnose early-TCMR is less well calibrated to account for these late shifts of inflammatory target and density, risking underdiagnosis of clinically significant late-TCMR. This document lays out the histopathologic characteristics of early- vs. late-TCMR and the rationale for updating the Banff scoring system for liver allograft rejection to better incorporate currently unrepresented histology feature sets correlating with a molecular rejection signature into the Banff rejection scheme.
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