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Introduction: The relevance of plasma cells in the allograft liver is of utmost importance and objective assessment of these infiltrates and correlation with other ancillary findings needs to be evaluated. Materials and Methods: Three hundred and sixty-eight graft liver biopsies received in the department from 2012 to 2022 and 115 allograft liver biopsies with histopathological diagnosis of rejection were selected. Based on plasma cells percentage in the portal tracts, the biopsies were divided into three groups: Group 1 showing not more than an occasional plasma cell, Group 2 showing 10% plasma cells. Rejection activity index (RAI), portal/lobular inflammation, interface activity, subendothelial inflammation (portal and central vein), duct damage/loss, presence of cholestasis, apoptosis, perivenulitis, necrosis, rosette along with serial liver function tests (LFTs), and patient status at 1 year of follow-up were recorded and compared between the groups. Results: Plasma cell infiltrates were observed in 52.6% of the specimens, with the mean percentage of plasma cells in the infiltrates being 4.9. Increased plasma cell infiltrates were associated with higher RAI scores, marked duct damage, marked portal and central vein endotheliitis, marked portal inflammation, and presence of interface activity. Higher levels of transaminitis were recorded at the time of biopsy, but no significant association was observed in the fall of serial LFTs over a 2-week period with the presence of plasma cells. Conclusion: Identifying plasma cell infiltrates in liver allografts can serve as a clue toward increased severity of rejection in liver allograft biopsies. Further studies with emphasis on correlation with the clinical outcome and response to treatment are needed to validate its utility as an objective tool.

Introduction: The relevance of plasma cells in the allograft liver is of utmost importance and objective assessment of these infiltrates and correlation with other ancillary findings needs to be evaluated. Materials and Methods: Three hundred and sixty‑eight graft liver biopsies received in the department from 2012 to 2022 and 115 allograft liver biopsies with histopathological diagnosis of rejection were selected. Based on plasma cells percentage in the portal tracts, the biopsies were divided into three groups: Group 1 showing not more than an occasional plasma cell, Group 2 showing <10% plasma cells, and Group 3 showing >10% plasma cells. Rejection activity index (RAI), portal/lobular inflammation, interface activity, subendothelial inflammation (portal and central vein), duct damage/loss, presence of cholestasis, apoptosis, perivenulitis, necrosis, rosette along with serial liver function tests (LFTs), and patient status at 1 year of follow‑up were recorded and compared between the groups. Results: Plasma cell infiltrates were observed in 52.6% of the specimens, with the mean percentage of plasma cells in the infiltrates being 4.9. Increased plasma cell infiltrates were associated with higher RAI scores, marked duct damage, marked portal and central vein endotheliitis, marked portal inflammation, and presence of interface activity. Higher levels of transaminitis were recorded at the time of biopsy, but no significant association was observed in the fall of serial LFTs over a 2‑week period with the presence of plasma cells. Conclusion: Identifying plasma cell infiltrates in liver allografts can serve as a clue toward increased severity of rejection in liver allograft biopsies. Further studies with emphasis on correlation with the clinical outcome and response to treatment are needed to validate its utility as an objective tool. [ABSTRACT FROM AUTHOR]

Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking. Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series. Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early ( 12) months] and were assessed for sixteen histological parameters. Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001). Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.

Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking., Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series., Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3-6), 3 and 4-late (6-12 and > 12) months] and were assessed for sixteen histological parameters., Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001)., Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration., Competing Interests: None