Pathological characteristics and clinical effect of autoimmune hepatitis after liver transplantation

Abstract

Objective To investigate the pathological characteristics and clinical effect of autoimmune (AIH) after liver transplantation. Methods The retrospective descriptive cross-sectional study was adopted. The clinicopathological data of 14 patients with AIH who underwent liver transplantation at the First Affiliated Hospital of Xi′an Jiaotong University between June 2011 and December 2015 were collected. Fourteen patients underwent orthotopic liver transplantation, specimens of total liver resection from 14 patients and aspiration specimens from liver allografts of 6 patients with severely abnormal liver function after liver transplantation were collected and detected by hematoxylin-eosin (HE) staining. Specimens of total liver resection continued to detect by reticular fiber staining and immunohistochemistry. The tissues construction was observed by light microscopy. Observation indicators included (1) intra- and post-operative situations, (2) results of pathological examination, (3) follow-up. The follow-up using outpatient examination and telephone interview was performed to detect the situations of immuno-suppressive therapy and survival of patients up to March 2016. Measurement data were represented as average (range). Results (1) Intra- and post-operative situations: all the 14 patients with AIH underwent successful liver transplantation without perioperative death. The operation time, duration of anhepatic period of liver transplantation, volume of intraoperative blood loss and duration of hospital stay were 402 minutes (range, 353-405 minutes), 50 minutes (range, 42-60 minutes), 2 800 mL (range, 1 325-4 050 mL) and 19 days (range, 12-24 days), respectively. Of 14 patients with AIH after liver transplantation, 6 were complicated with pulmonary infection, 2 with acute rejection, 2 with bile duct strictures and 1 with acute renal failure, and they were improved by symptomatic treatment. (2) Results of pathological examination: HE staining of specimens of total liver resection showed that different levels of hepatitis were detected in 14 patients, lymphocytes penetration phenomena in 14 patients, lymphoplasmacytic interface hepatocyte necrosis in 9 patients, infiltration of plasma cells in 9 patients, spotty and piecemeal necroses in 5 patients and rosettes-like structure in 4 patients. HE staining of specimens of liver allografts showed that lymphoplasmacytic interface hepatocyte necroses were detected in 4 patients, rosettes-like structure in 4 patients, cholestatic cirrhosis in 3 patients, mildly acute rejection in 2 patients and recurrence of AIH in 1 patient. Reticular fiber staining: fibrous tissues were proliferative in the portal area and then separated and surrounded hepatocytes to form pseudolobule structure. Immunohistochemistry: inflammatory cells infiltrated by liver tissues were composed of T cells with mainly positive CD3 and CD8 and with few positive CD4. (3) Follow-up: 14 patients were followed up for 26 months (range, 3-57 months). Fourteen patients received regular immuno-suppressive therapy. During follow-up, 1 patient was complicated with primary transplants nonfunction, 2 had AIH recurrence and 3 were dead. Conclusions Patients with AIH should enhance hormone therapy due to high incidences of bile duct complications and pulmonary infection after liver transplantation. Lymphoplasmacytic interface hepatocyte necrosis and rosettes-like structure probably have worse prognosis. Dysfunction of Regulatory T cells (T-reg) may be a prognosis predictor for AIH after liver transplantation. Key words: Autoimmune hepatitis; Liver transplantation; Pathology; Prognosis