Fig. 1Frequency of allograft dysfunction by underlying disease. HBV, hepatitis B virus; HCV, hepatitis C virus; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis.
Fig. 2Causes of late allograft dysfunction according to underlying liver diseases before liver transplantation. HBV, hepatitis B virus; HCV, hepatitis C virus; BC, biliary complication; ACR, acute cellular rejection.
Fig. 3Causes of late allograft dysfunction by period after liver transplantation. BC, biliary complication; ACR, acute cellular rejection; ELP, early-late period; MLP, mid-late period; LLP, late-late period.
Fig. 4Histological comparison between late acute rejection and recurrent hepatitis B virus (HBV)-associated hepatitis. ACR, acute cellular rejection; PMN, piecemeal necrosis.
Fig. 5Representative features of major causes of late allograft dysfunction. (A) Acute cellular rejection: bile duct damage and vascular endothelialitis. (B) Recurrent hepatitis B virus-associated hepatitis: lymphoplasma cells infiltration in portal tract with interface activity. Biliary complication; neutrophilic infiltration in portal tract (C) and bile ductular proliferation (cytokeratin 19) (D).
Table 1.Demography of the study population
|
|
n (%) |
Age (yr) |
|
47.72 ± 10.17 |
Sex |
Male |
134 (77) |
Female |
40 (23) |
Underlying disease |
HBV-associated liver disease |
134 (77.0) |
HCV-associated liver disease |
15 (8.6) |
Drug/alcohol associated liver disease |
18 (10.3) |
PBC |
2 (1.2) |
PSC |
2 (1.2) |
Metabolic liver disease |
3 (1.7) |
Interval between LT and biopsy |
|
16.61 ± 18.98 mo |
Early-late perioda
|
63 (36.2) |
Mid-late periodb
|
37 (21.3) |
Late-late periodc
|
74 (42.5) |
Table 2.Causes of late allograft dysfunction
Causes |
n (%) |
ACR |
80 (32.5) |
Recurred disease |
47 (19.1) |
BDO |
41 (17.1) |
Combined cause |
22 (8.9) |
ACR+BDO |
9 (40.9) |
Recurred disease+ACR |
7 (31.8) |
Other viral infection+ACR |
2 (9.1) |
Recurred disease+BDO |
2 (9.1) |
Ischemic injury+recurred disease |
2 (9.1) |
Chronic rejection |
13 (5.3) |
Ischemic injury |
9 (3.7) |
Other viral infection |
7 (2.8) |
Sepsis |
3 (1.2) |
Toxic injury |
1 (0.4) |
Indeterminate |
22 (8.9) |
Total |
245 (100) |