C-Kit–Positive Mast Cells in Portal Tracts Cannot Be Used to Distinguish Acute Cellular Rejection From Recurrent Hepatitis C Infection in Liver Allografts

Abstract

Cirrhosis secondary to chronic hepatitis C virus (HCV) is the most common indication for liver transplantation. Recurrence of HCV infection in the liver allograft occurs at a high rate. The differentiation of recurrent HCV infection from acute cellular rejection (ACR) represents a difficult challenge in transplantation pathology. The c-Kit receptor is a tyrosine kinase membrane protein encoded by the c-Kit proto-oncogene, which is expressed on mast cells and on hematopoietic stem and progenitor cells. Mast cells are important effector cells of a broad range of immune responses. Recently, c-Kit + mast cells were shown to form part of the inflammatory infiltrate in acute liver allograft rejection. A strong relationship was found between c-Kit + cell densities and increasingly severe rejection. The present study sought to determine whether the presence of c-Kit + cells could be used to distinguish between ACR and recurrent HCV in liver allografts. Immunohistochemical staining for c-Kit was performed on 20 transplant biopsy specimens from 10 patients with mild to moderate ACR and 10 other patients with recurrent hepatitis C. The number of c-Kit + cells per portal tract varied with the density of the overall inflammatory infiltrate. There was no significant difference between the number of c-Kit + cells in the biopsy specimens that carried a diagnosis of ACR and those from patients who had been diagnosed as having recurrent HCV. It was concluded that immunohistochemical staining for the presence of c-Kit + mast cells cannot be used to differentiate between ACR and recurrent HCV infection in liver allograft biopsy specimens.