Introduction
Histopathological assessment of liver biopsies is the current “gold standard” for diagnosing graft dysfunction after liver transplantation (LT) as graft dysfunction can have non-specific clinical presentations and inconsistent patterns of liver biochemical dysfunction. Most commonly post LT, graft dysfunction within the first year is due to acute T-cell mediated rejection (TCMR) which is characterised histologically by the
degree of portal inflammation (PI), bile duct damage (BDD) and venous endothelial inflammation (VEI). This study aimed to establish the relationship between global assessment and rejection activity index (RAI) of each component of TCMR as described in revised Banff 2016 guidelines using liver biopsies performed at the Australian National Liver Transplant Unit (ANLTU) at Royal Prince Alfred Hospital.
Method/Description
Liver biopsies taken from patients who underwent LT in 2015 and 2016 were identified from the electronic medical records. All biopsy slides were microscopically graded by at least two assessors independently using the revised 2016 Banff criteria. Data was analysed using IBM SPSS v21.
Results
Within the cohort, 60 (37%, n=164) patients underwent at least 1 biopsy within 12-months after LT. The most common biopsy outcome (total n=90) was acute TCMR (64, 71.1%). Global assessment of TCMR slides strongly positively correlated with PI (p-value< 0.001), BDD (p-value< 0.001), VEI (p-value <0.001), and total RAI (p-value< 0.001). Liver biochemistry of patients with TCMR significantly improved within 4 to 6 weeks post biopsy compared to the day of the biopsy.
Consclusions
In acute TCMR, global assessment and total RAI are strongly correlated and can be used interchangeably.