Journal of Pathology and Translational Medicine

Review

Post-transplant liver biopsies: a concise and practical approach for beginners: Mohamad Besher Ourfali, David Hirsch, Marianna Scranton, Tony El Jabbour; J Pathol Transl Med. 2025;59(1):1-10. Published online January 15, 2025; DOI: https://doi.org/10.4132/jptm.2024.11.15

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Abstract PDF: Exposure to post-transplant liver biopsies varies among pathology residencies and largely depends on the institution's training program, particularly if the hospital has a liver transplant program. The interpretation of biopsies from transplanted livers presents its own set of challenges, even for those with a solid understanding of non-transplant medical liver biopsies. In this review, we aim to provide a succinct, step-by-step approach to help you interpret liver transplant biopsies. This article may be beneficial for residents interested in liver pathology, gastrointestinal and liver pathology fellows in the early stages of training, clinical gastroenterology and hepatology fellows, hepatologists and general pathologists who are curious about this niche.

Original Articles

Quilty Lesions in the Endomyocardial Biopsies after Heart Transplantation: Haeyon Cho, Jin-Oh Choi, Eun-Seok Jeon, Jung-Sun Kim; J Pathol Transl Med. 2019;53(1):50-56. Published online December 26, 2018; DOI: https://doi.org/10.4132/jptm.2018.11.30

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Background
The aim of this study was to investigate the clinical significance of Quilty lesions in endomyocardial biopsies (EMBs) of cardiac transplantation patients.
Methods
A total of 1190EMBs from 117 cardiac transplantation patients were evaluated histologically for Quilty lesions,acute cellular rejection, and antibody-mediated rejection. Cardiac allograft vasculopathy wasdiagnosed by computed tomography coronary angiography. Clinical information, including thepatients’ survival was retrieved by a review of medical records.
Results
Eighty-eight patients(75.2%) were diagnosed with Quilty lesions, which were significantly associated with acute cellularrejection, but not with acute cellular rejection ≥ 2R or antibody-mediated rejection. In patientsdiagnosed with both Quilty lesions and acute cellular rejection, the time-to-onset of Quilty lesionsfrom transplantation was longer than that of acute cellular rejections. We found a significant associationbetween Quilty lesions and cardiac allograft vasculopathy. No significant relationship wasfound between Quilty lesions and the patients’ survival.
Conclusions
Quilty lesion may be an indicator of previous acute cellular rejection rather than a predictor for future acute cellular rejection.

Citations

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The human myocardium harbors a population of naive B-cells with a distinctive gene expression signature conserved across species
Kevin C. Bermea, Nicolas Kostelecky, Sylvie T. Rousseau, Chieh-Yu Lin, Luigi Adamo
Frontiers in Immunology.2022;[Epub] CrossRef
Examination of tracheal allografts after long-term survival in dogs
Tao Lu, Yiwei Huang, Yulei Qiao, Yongxing Zhang, Yu Liu
European Journal of Cardio-Thoracic Surgery.2021; 59(1): 155. CrossRef
Essentials in the diagnosis of postoperative myocardial lesions similar to or unrelated to rejection in heart transplant
Costel Dumitru, Ancuta Zazgyva, Adriana Habor, Ovidiu Cotoi, Horațiu Suciu, Carmen Cotrutz, Bogdan Grecu, Ileana Anca Sin
Revista Romana de Medicina de Laborator.2021; 29(3): 307. CrossRef
Clinical outcome of donor heart with prolonged cold ischemic time: A single‐center study
Fazal Shafiq, Yixuan Wang, Geng Li, Zongtao Liu, Fei Li, Ying Zhou, Li Xu, Xingjian Hu, Nianguo Dong
Journal of Cardiac Surgery.2020; 35(2): 397. CrossRef
The XVth Banff Conference on Allograft Pathology the Banff Workshop Heart Report: Improving the diagnostic yield from endomyocardial biopsies and Quilty effect revisited
Jean-Paul Duong Van Huyen, Marny Fedrigo, Gregory A. Fishbein, Ornella Leone, Desley Neil, Charles Marboe, Eliot Peyster, Jan von der Thüsen, Alexandre Loupy, Michael Mengel, Monica P. Revelo, Benjamin Adam, Patrick Bruneval, Annalisa Angelini, Dylan V. M
American Journal of Transplantation.2020; 20(12): 3308. CrossRef

Prognosis of Hepatocellular Carcinoma after Liver Transplantation: Comparative Analysis with Partial Hepatectomy: Kyuho Lee, Kyoung-Bun Lee, Nam-Joon Yi, Kyung-Suk Suh, Ja-June Jang; J Pathol Transl Med. 2017;51(1):79-86. Published online December 25, 2016; DOI: https://doi.org/10.4132/jptm.2016.10.13

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Abstract PDF

Background
Liver transplantation (LT) is the treatment of choice for hepatocellular carcinoma (HCC). The aim of this study was to investigate the recurrence rate of HCC after LT and prognostic factors for recurrence by comparing LT with non-transplanted resection. Methods: The participants were 338 patients who underwent LT between 1996 and 2012 at Seoul National University Hospital (LT group) and 520 HCC patients who underwent partial hepatectomy between 1995 and 2006 (control group, non-LT group). Results: In the LT group, 68 of 338 patients (19.8%) showed relapse, and the recurrence rate was lower than that in the non-LT group (64.9%, 357/520, p < .001). Stratification analysis by American Joint Committee on Cancer (AJCC) stage showed that the stage I-II LT group had a lower recurrence rate than the non-LT group. Univariate comparative analysis demonstrated that multiplicity of tumor, tumor size, gross type, Edmondson- Steiner (ES) nuclear grade, extent of tumor, angioinvasion, AJCC stage, Milan criteria, University of California at San Francisco criteria on explant pathology (all p < .001), positive expression of cytokeratin 19 (p = .002), and preoperative α-fetoprotein (AFP) (p < .001) were predictors of tumor recurrence. In multivariate analysis, LT, preoperative AFP, multiplicity of tumor, extent of tumor, size of tumor, and ES nuclear grade were independent prognostic factors. Conclusions: LT might have a protective effect against the late recurrence of stage I-II HCC compared to non-LT, and the prognostic factors for recurrence were similar to previously well-known prognostic factors for HCC.

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Related Factors of Hepatocellular Carcinoma Recurrence Associated With Hyperglycemia After Liver Transplantation
Yujian Zheng, Qing Cai, Lishan Peng, Shibo Sun, Shaoping Wang, Jie Zhou
Transplantation Proceedings.2021; 53(1): 177. CrossRef
Oncological Outcomes of Hepatic Resection vs Transplantation for Localized Hepatocellular Carcinoma
A.T. Akcam, A.G. Saritas, A. Ulku, A. Rencuzogullari
Transplantation Proceedings.2019; 51(4): 1147. CrossRef
Clustering Asian Countries According to the Trend of liver cancer Mortality Rates: an Application of Growth Mixture Models
Maryam Salari, Anoshirvan Kazemnejad, Farid Zayeri
Iranian Red Crescent Medical Journal.2017;[Epub] CrossRef

Expression of CD99 in Multiple Myeloma: A Clinicopathologic and Immunohistochemical Study of 170 Cases: Su-Jin Shin, Hyangsin Lee, Geunyoung Jung, Minchan Gil, Hosub Park, Young Soo Park, Dok Hyun Yoon, Cheolwon Suh, Chan-Jeoung Park, Jooryung Huh, Chan-Sik Park; Korean J Pathol. 2014;48(3):209-216. Published online June 26, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.3.209

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Abstract PDF

Background

Multiple myeloma (MM) is a heterogeneous and ultimately fatal disease. Risk stratification using prognostic biomarkers is crucial to individualize treatments. We sought to investigate the role of CD99, a transmembrane protein highly expressed in many hematopoietic cells including subpopulations of normal and neoplastic plasma cells, for MM risk stratification.

Methods

CD99 expression was measured in paraffin samples of bone marrow and extramedullary biopsies of 170 patients with MM. Patients were divided into those with high score (moderately and strongly positive) and low score (negative and weakly positive), with all staining being cytoplasmic and/or membranous.

Results

High anti-CD99 immunostaining was observed in 72 of 136 (52.9%) bone marrow biopsies and 24 of 87 (27.6%) extramedullary biopsies in MM. High CD99 expression of extramedullary specimens was associated with significantly longer overall survival (OS; p=.016). High CD99 expression of extramedullary specimens was also associated with better prognosis in the nonautologous stem cell transplantation group of MM patients (p=.044). In multivariate analysis, International Staging System stage was an independent prognostic factor, whereas CD99 expression was no longer statistically significant.

Conclusions

Expression of CD99 in extramedullary specimens was correlated with longer OS, suggesting that CD99 may be a helpful immunohistochemical marker for risk stratification.

Citations

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Luzalba Sanoja-Flores, Juan Flores-Montero, Martín Pérez-Andrés, Noemí Puig, Alberto Orfao
Cancers.2020; 12(6): 1499. CrossRef
Tumor suppressor CD99 is downregulated in plasma cell neoplasms lacking CCND1 translocation and distinguishes neoplastic from normal plasma cells and B-cell lymphomas with plasmacytic differentiation from primary plasma cell neoplasms
Qi Gao, Venkata Yellapantula, Maly Fenelus, Janine Pichardo, Lu Wang, Ola Landgren, Ahmet Dogan, Mikhail Roshal
Modern Pathology.2018; 31(6): 881. CrossRef
EWSR1 fusion proteins mediate PAX7 expression in Ewing sarcoma
Gregory W Charville, Wei-Lien Wang, Davis R Ingram, Angshumoy Roy, Dafydd Thomas, Rajiv M Patel, Jason L Hornick, Matt van de Rijn, Alexander J Lazar
Modern Pathology.2017; 30(9): 1312. CrossRef
Activation of the polycomb repressive complex pathway in the bone marrow resident cells of diffuse large B-cell lymphoma patients
Eun Ji Oh, Eun Kyung Kim, Woo Ick Yang, Sun Och Yoon
Leukemia & Lymphoma.2016; 57(8): 1921. CrossRef
CD99 Is Strongly Expressed in Basal Cells of the Normal Adult Epidermis and Some Subpopulations of Appendages: Comparison with Developing Fetal Skin
Gawon Choi, Jin Roh, Chan-Sik Park
Journal of Pathology and Translational Medicine.2016; 50(5): 361. CrossRef
Towards Stratified Medicine in Plasma Cell Myeloma
Philip Egan, Stephen Drain, Caroline Conway, Anthony Bjourson, H. Alexander
International Journal of Molecular Sciences.2016; 17(10): 1760. CrossRef
Human Myeloma Cell Lines Induce Osteoblast Downregulation of CD99 Which Is Involved in Osteoblast Formation and Activity
Angela Oranger, Giacomina Brunetti, Claudia Carbone, Graziana Colaianni, Teresa Mongelli, Isabella Gigante, Roberto Tamma, Giorgio Mori, Adriana Di Benedetto, Marika Sciandra, Selena Ventura, Katia Scotlandi, Silvia Colucci, Maria Grano
Journal of Immunology Research.2015; 2015: 1. CrossRef
CD99 regulates CXCL12-induced chemotaxis of human plasma cells
Minchan Gil, Hyo-Kyung Pak, A-Neum Lee, Seo-Jung Park, Yoonkyung Lee, Jin Roh, Hyunji Lee, Yoo-Sam Chung, Chan-Sik Park
Immunology Letters.2015; 168(2): 329. CrossRef

Case Study

Silent Colonic Malakoplakia in a Living-Donor Kidney Transplant Recipient Diagnosed during Annual Medical Examination: Go Eun Bae, Nara Yoon, Ha Young Park, Sang Yun Ha, Junhun Cho, Yunkyung Lee, Kyoung-Mee Kim, Cheol Keun Park; Korean J Pathol. 2013;47(2):163-166. Published online April 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.2.163

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Abstract PDF

Malakoplakia is a characteristic inflammatory condition, which is usually seen in the urogenital tract, and less frequently in the gastrointestinal tract. We present a case of colonic malakoplakia in an immunocompromised patient. A 55-year-old female visited the outpatient clinic for routine cancer surveillance. Her past medical history was significant for kidney transplantation 11 years ago, and she had been taking immunosuppressants. A colonoscopy revealed several depressed flat lesions and elevated polyps, which were 0.3 to 0.4 cm in size and accompanied by whitish exudates. A biopsy revealed an infiltration of histiocytes with ample granular eosinophilic cytoplasm, with some lymphocytes and plasma cells. Many histiocytes had the characteristic morphology, described as Michaelis-Gutmann bodies: one or several round basophilic structures of approximately 1 to 10 µm in size with some being laminated, some appearing homogeneous, and others having a dense central core with a targetoid appearance. These Michaelis-Gutmann bodies were positively stained on von Kossa stain, and were diagnostic for malakoplakia.

Citations

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Malakoplakia in kidney transplant recipients: Three case reports
Prathap Kumar Simhadri, Renish Contractor, Deepak Chandramohan, Matthew McGee, Udit Nangia, Mohammad Atari, Syed Bushra, Sanjana Kapoor, Ramya Krishna Velagapudi, Pradeep K Vaitla
World Journal of Nephrology.2025;[Epub] CrossRef
Caecal malakoplakia: a rare mimic of malignancy
Jeffrey Li Voon Chong, Noor Ali
BMJ Case Reports.2024; 17(1): e257130. CrossRef
A Surgical Challenge Generated by Colonic Malakoplakia in Disguise as a Locally Advanced Colonic Malignancy—A Case Report
Cristina Șerban, Alexandra Toma, Dragoș Cristian Voicu, Constantin Popazu, Dorel Firescu, George Țocu, Raul Mihailov, Laura Rebegea
Medicina.2023; 59(1): 156. CrossRef
Colonic malakoplakia in a cardiac transplant recipient: A case report
Sadiya Shafijan
Indian Journal of Pathology and Microbiology.2020; 63(2): 322. CrossRef
Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients
Merel M. Tielemans, Gerben A.J. van Boekel, Teun van Gelder, Eric T. Tjwa, Luuk B. Hilbrands
Transplantation Reviews.2019; 33(2): 55. CrossRef
Malakoplakia of the colon following renal transplantation in a 73 year old woman: report of a case presenting as intestinal perforation
Andrew Mitchell, Alexandre Dugas
Diagnostic Pathology.2019;[Epub] CrossRef
Colonic malakoplakia in a liver transplant recipient: A case report
Rana Ajabnoor, Mohammad Mawardi, Abdulmonem Almutawa
Human Pathology: Case Reports.2019; 18: 200323. CrossRef
Malakoplakia after kidney transplantation: Case report and literature review
John Fredy Nieto‐Ríos, Isabel Ramírez, Mónica Zuluaga‐Quintero, Lina María Serna‐Higuita, Federico Gaviria‐Gil, Alejandro Velez‐Hoyos
Transplant Infectious Disease.2017;[Epub] CrossRef
Megalocytic Interstitial Nephritis Following Acute Pyelonephritis with Escherichia coli Bacteremia: A Case Report
Hee Jin Kwon, Kwai Han Yoo, In Young Kim, Seulkee Lee, Hye Ryoun Jang, Ghee Young Kwon
Journal of Korean Medical Science.2015; 30(1): 110. CrossRef

Original Article

Histopathological Causes of Late Liver Allograft Dysfunction: Analysis at a Single Institution: Eun Shin, Ji Hoon Kim, Eunsil Yu; Korean J Pathol. 2013;47(1):21-27. Published online February 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.1.21

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Abstract PDF

Background

We summarize our experience in the pathological diagnosis of late complications of liver transplantation (LT) to better understand the causes of late allograft dysfunction in a population mostly composed of patients with hepatitis B virus (HBV) infection.

Methods

We reviewed 361 post-transplant liver biopsies from 174 patients who underwent LT and first presented with liver function abnormalities 3 months post-procedure. The underlying diseases included HBV-associated liver disease (77%), toxic or alcoholic liver disease (10.3%), hepatitis C virus (HCV)-associated liver disease (8.6%), primary biliary cirrhosis (1.2%), primary sclerosing cholangitis (1.2%), and metabolic disease (1.7%).

Results

The three most common late complications were acute rejection (32.5%), recurrent disease (19.1%), and biliary complication (17.1%). Patients who underwent LT for HBV infection or for drug- or alcohol-related liver disease had a lower incidence of recurring disease than those who underwent transplantation for HCV infection. During post-transplantation months 3-12, acute rejection was the most common cause of allograft dysfunction and recurring disease was the leading cause for allograft dysfunction (p=0.039). The two primary causes of late allograft dysfunction have overlapping histological features, although acute rejection more frequently showed bile duct damage and vascular endothelialitis than recurring HBV infection, and recurring HBV infection had more frequent lobular activity and piecemeal necrosis.

Conclusions

The causes of late liver allograft dysfunction are closely associated with the original liver diseases and the period after LT. Careful attention is required for differential diagnosis between acute rejection and recurrent HBV.

Citations

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Liver Transplantation from a Human Leukocyte Antigen-Matched Sibling Donor: Effectiveness of Direct-Acting Antiviral Therapy against Hepatitis C Virus Infection
Tatsuo Kanda, Naoki Matsumoto, Tomotaka Ishii, Shuhei Arima, Shinji Shibuya, Masayuki Honda, Reina Sasaki-Tanaka, Ryota Masuzaki, Shini Kanezawa, Masahiro Ogawa, Shintaro Yamazaki, Osamu Aramaki, Hirofumi Kogure, Yukiyasu Okamura
Reports.2022; 5(4): 49. CrossRef
A comparative histological analysis of early and late graft dysfunction in different time zones following living donor liver transplantation
Archana Rastogi, Nayana Patil, Sphurti Srivastava, Gayatri Ramakrishna, Rakhi Maiwal, Guresh Kumar, Ashok K. Choudhary, Seema Alam, Chhagan Bihari, Viniyendra Pamecha
Indian Journal of Pathology and Microbiology.2022; 65(4): 802. CrossRef
Differences in risk factors for early-onset and late-onset biliary complications in liver transplant patients
Hsiu-Lung Fan, An-Chieh Feng, Meng-Hsing Ho, Shih-Ming Kuo, Wei-Chou Chang, Teng-Wei Chen
Journal of Medical Sciences.2015; 35(5): 201. CrossRef
Vitamin C exerts beneficial hepatoprotection against Concanavalin A-induced immunological hepatic injury in mice through inhibition of NF-κB signal pathway
Tao Liang, Xiaoyu Chen, Min Su, Hongqiu Chen, Guozhe Lu, Kun Liang
Food & Function.2014; 5(9): 2175. CrossRef

Case Report

Clinicopathologic Analysis of the Liver Explant with Severe Hepatitis A Virus Infection.: Joo Young Kim, Sung Gyu Lee, Shin Hwang, Ji Hoon Kim, Se Jin Jang, Eunsil Yu; Korean J Pathol. 2011;45:S48-S52.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S48

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Abstract PDF: The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.

Original Articles

Newly Formed Hepatic Masses in Children with Biliary Atresia after Kasai Hepatic Portoenterostomy.: Hye Jong Song, Yeon Lim Suh; Korean J Pathol. 2011;45(2):160-169.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.2.160

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Abstract PDF

BACKGROUND
This report describes the clinicopathologic findings of six hepatic masses that developed after Kasai hepatic portoenterostomy (HPE) in six patients with longstanding biliary atresia (BA).
METHODS
Hepatic masses were found in six of 55 pediatric patients who underwent liver transplantation for BA after Kasai HPE from 1997 to 2009. Clinicopathologic analysis was performed and immunohistochemical staining was carried out for CD34, smooth muscle actin (SMA) and cytokeratin 7.
RESULTS
Of the six hepatic masses, two were diagnosed as focal nodular hyperplasia (FNH)-like lesions, two were large regenerative nodules (LRN), one was a mesenchymal hamartoma (MH) and one was a cholangiocarcinoma. The immunohistochemical staining findings for SMA and CD34 were more prominent for the FNH-like nodules than for the cirrhotic background liver. Dysplastic biliary epithelium arising from intestinal metaplasia was found in the cholangiocarcinoma.
CONCLUSIONS
Our findings suggest that FNH-like lesions, LRNs and MH are the results of vascular hemodynamic changes after Kasai HPE and that cholangiocarcinoma is due to recurrent cholangitis after BA. All the lesions in this series must be included in the differential diagnosis of a newly formed hepatic mass in patients after portoenterostomy.

Citations

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Imaging Findings and Management Strategies for Liver Masses in Children with Predisposition Disorders: A Review by the Pediatric LI-RADS Group
Amy B. Kolbe, Michael R. Acord, Geetika Khanna, Cara E. Morin, HaiThuy N. Nguyen, Mitchell A. Rees, Esther Ro, Gary R. Schooler, Judy H. Squires, Ali B. Syed, Elizabeth R. Tang, Alexander J. Towbin, Adina Alazraki
RadioGraphics.2025;[Epub] CrossRef
Features of Nodules in Explants of Children Undergoing Liver Transplantation for Biliary Atresia
Ana M. Calinescu, Anne-Laure Rougemont, Mehrak Anooshiravani, Nathalie M. Rock, Valerie A. McLin, Barbara E. Wildhaber
Journal of Clinical Medicine.2022; 11(6): 1578. CrossRef
Biliary Atresia Patients With Successful Kasai Portoenterostomy Can Present With Features of Obliterative Portal Venopathy
Kalyani R. Patel, Sanjiv Harpavat, Zahida Khan, Sadhna Dhingra, Norma Quintanilla, Mihail Firan, John Goss
Journal of Pediatric Gastroenterology and Nutrition.2020; 71(1): 91. CrossRef

Comparison of Detecting Methods of BK Virus Infection in Patients with Renal Allograft Recipients.: Sung Hak Lee, Youn Jun Park, Chul Woo Yang, Yong Soo Kim, In Sung Moon, Chang Suk Kang, Yeong Jin Choi; Korean J Pathol. 2010;44(6):636-641.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.636

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Abstract PDF

BACKGROUND
BK virus nephropathy (BKVN) is an emerging problem as a consequence of the use of potent immunosuppressive agents. Because optimal detection methods for the diagnosis of BKVN are required clinically, we compared the results of renal allograft biopsy, urine cytology, and urine and blood viral loads.
METHODS
Four hundred sixty two case notes from 2004 to 2009 at Seoul St. Mary's Hospital were reviewed. During that period, 286 cases of urine cytology for decoy cells, 938 cases of urine BKV reverse transcription-polymerase chain reaction (RT-PCR), and 1,029 cases of blood BKV RT-PCR were performed. All diagnostic methods were performed in 85 cases.
RESULTS
A histological diagnosis of BKVN was made in 2.4% of cases (11/462). Urine cytology for decoy cells was positive in 26.2% (75/286). BKV RT-PCR revealed viruria in positivity of 22.1% (207/938) and viremia in 5.2% (54/1,029). In cases of BKVN, the sensitivities of urine and blood BKV RT-PCR were all 100% and the specificities were 69% and 94.5%, respectively. In cases with positive urine decoy cells, the sensitivities of urine and blood BKV RT-PCR were 50% and 27.7%, with specificities of 77.7% and 100%, respectively.
CONCLUSIONS
BKV screening by RT-PCR assays may be a clinically useful noninvasive test to identify renal recipients with concurrent BKVN.

Citations

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Prevalence of BK Virus among Iranian Renal Transplant Recipients: A Systematic Review and Meta-Analysis
Mohsen Ebrahimi, Alireza Mohebbi, Mohammad Mostakhdem Hashemi, Mobina Ashrafi Shahmirzadi
Journal of Clinical and Basic Research.2020; 4(4): 50. CrossRef
Asymptomatic hematuria associated with urinary polyomavirus infection in immunocompetent patients
Sung Hak Lee, Sung Hoo Hong, Ji Youl Lee, Tae Kon Hwang, Kyoung Suk Kim, Hyoungnam Lee, Yeong Jin Choi
Journal of Medical Virology.2014; 86(2): 347. CrossRef

Characterization of Histopathological Features that Differentiate Hepatitis B Virus Infection from Acute Cellular Rejection.: Dong Eun Song, Dong Hwan Jung, Shin Hwang, Bong Hee Park, Eunsil Yu; Korean J Pathol. 2009;43(6):535-541.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.535

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Abstract PDF

BACKGROUND
Differentiation of viral hepatitis from acute cellular rejection (ACR) after liver transplantation can be difficult because of overlapping histological features. Here we investigated clinicopathologic characteristics of 311 liver allograft biopsies and searched for characteristic histopathological features that would facilitate the differential diagnosis between hepatitis B virus (HBV) infection and ACR. METHODS: A retrospective clinicopathologic examination of 311 liver allograft biopsies consisting of clinically proven ACR or HBV infection was performed. Immunohistochemical staining for HBcAg and HBsAg was done for 64 allograft biopsies showing HBV infection. RESULTS: Moderate to severe bile duct damage, diffuse centrilobular necrosis and centrilobular inflammation (p<0.000, for each) were more frequently observed in cases of ACR, whereas diffuse acidophilic bodies and spotty necrosis (p<0.000, for each) were more prevalent in cases of HBV infection. Immunopositivity for HBcAg (n=60, 93.8%) was higher than that for HBsAg (n=14, 21.9%) CONCLUSIONS: The presence of moderate to severe bile duct damage, diffuse centrilobular necrosis and centrilobular inflammation was a characteristic feature of ACR, whereas diffuse distribution of acidophilic bodies or spotty necrosis was the only characteristic feature of HBV infection. HBcAg was a more sensitive immunohistochemical marker than HBsAg for detecting HBV infection in liver allograft biopsies.

Citations

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Analysis of S Gene Mutation of the Hepatitis B Virus in Adult Liver Transplant Recipients Showing Resistance to Hepatitis B Immunoglobulin Therapy
G.-C. Park, S. Hwang, C.-S. Ahn, K.-H. Kim, D.-B. Moon, T.-Y. Ha, G.-W. Song, D.-H. Jung, Y.W. Shin, S.-H. Kim, K.-H. Chang, J.-M. Namgoong, C.-S. Park, H.-W. Park, Y.-H. Park, S.-H. Kang, B.-H. Jung, S.-G. Lee
Transplantation Proceedings.2013; 45(8): 3047. CrossRef
Posttransplantation prophylaxis with primary high-dose hepatitis B immunoglobulin monotherapy and complementary preemptive antiviral add-on a
Shin Hwang, Chul-Soo Ahn, Gi-Won Song, Ki-Hun Kim, Deok-Bog Moon, Heung-Bum Oh, Young-Suk Lim, Han Chu Lee, Tae-Yong Ha, Dong-Hwan Jung, Young-Hwa Chung, Sung-Gyu Lee
Liver Transplantation.2011; 17(4): 456. CrossRef
Posttransplantation Prophylaxis with Primary High-dose Hepatitis B Immunoglobulin Monotherapy and Complementary Preemptive Antiviral Add-on. Liver Transpl 2011;17:456-465
Dong-Hwan Jung, Shin Hwang
The Korean Journal of Gastroenterology.2011; 57(5): 330. CrossRef

Case Report

Graft-Versus-Host Disease of the Lung after Allogeneic Hematopoietic Stem Cell Transplantation: A Report of Two Cases.: Ji Hyeon Roh, Joungho Han, Keon Hee Yoo, Kang Mo Ahn, Jihye Kim; Korean J Pathol. 2009;43(4):378-381.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.4.378

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Abstract PDF: Herein, we describe cases of pulmonary acute graft-versus-host disease (aGVHD) in two patients occurring after allogeneic hematopoietic stem cell transplantation (HSCT) due to precursor B-cell acute lymphoblastic leukemia in a 6-year-old patient and in acute myeloid leukemia in a 14-year-old boy. In both cases, chest CT revealed confluent ground-glass attenuation along the bronchovascular bundles, as well as some bronchial dilatation. Microscopically, in both cases we noted a characteristic bronchiolocentric pattern and bronchiolar epithelial changes, which included denudation of the bronchiolar epithelium, regenerating atypical cells, and wall thickening with subepithelial or transmural fibroblast proliferation, along with some lymphocytic infiltration. One patient died on day 86 after allogeneic HSCT due to sudden acute respiratory distress syndrome, and the other patient currently remains alive without active aGVHD. The authors' experiences in these two cases demonstrate that intense awareness of the pathologic findings of GVHD is mandatory after allogeneic HSCT.

Original Articles

Alteration of Bile Acid Transporter Expression in Patients with Early Cholestasis Following Living Donor Liver Transplantation.: Eun Sun Jung, Byung Kee Kim, So Youn Kim, Youn Soo Lee, Si Hyun Bae, Seung Kew Yoon, Jong Young Choi, Young Min Park, Dong Goo Kim; Korean J Pathol. 2009;43(1):48-55.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.48

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Abstract PDF: BACKGROUND
Intrahepatic cholestasis can occur early after living donor liver transplantation (LDLT). We investigated the changes in the expressions of the bile acid transporters and the liver histology in the patients who suffered with early cholestasis (EC) following LDLT.
METHODS
The histological differences between 15 graft livers with EC after LDLT and 5 graft livers with biliary stricture following LDLT were evaluated. The hepatic mRNA levels of the bile canaliculi transporters (BSEP, MRP2, MRP3, MDR1, MDR3, NTCP) in 40 (20 graft livers, 20 matched donor livers) liver biopsy tissues were analyzed by performing real-time reverse-transcription polymerase chain reaction (RT-PCR).
RESULTS
Microscopic examination revealed hepatocellular and/or bile canalicular cholestasis around acinar zone 3 in the livers of the patients with EC. In the livers with biliary stricture, the cholestasis was dominantly observed in the hepatocytic cytoplasm and in the bile ductules around the portal area rather than around acinar zone 3. The BSEP and MRP2 mRNA levels in the EC livers were significantly reduced by 44% and 23%, respectively (p=0.000), compared to the matched donor livers. The levels of MDR3 and NTCP mRNA in the EC livers increased by 738% (p=0.000) and 281% (p<0.01), respectively. The change of the expressions of the bile acid transporters in the patients with biliary stricture was less significant than that in the EC group.
CONCLUSIONS
These results suggest that the altered expressions of the bile acid transporters may play a role in the pathogenesis of EC following LDLT.

Pathological Analysis of Post-Transplantation Endomyocardial Biopsies.: Jaegul Chung, Soonae Oak, Gheeyoung Choe, Gyungyub Gong, Jooryung Huh, Eunsil Yu, Inchul Lee, Meong Gun Song, Kwang Hyun Sohn, Jae Joong Kim, Jong Goo Lee; Korean J Pathol. 1995;29(4):431-441.

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Abstract PDF: Heart transplantation was first performed in 1967. It is now regarded as a well-established treatment modality for end-stage cardiac diseases. Once the transplantation is performed, endomyocardial biopsy(EMB) is the examination of choice in monitoring the transplanted heart. We analyzed the pathological findings of follow-up EMB of 6 heart transplant patients. All patients have been suffered from severe heart failure. Four patients were adult male and two were adult females. All the hearts, except for one, displayed characteristic features of dilated cardiomyopathy. The remaining heart was diagnosed as having giant cell myocarditis. Post-transplantion EMBs were performed according to the protocol and standard cardiac biopsy grading of ISHT (1990). The standards were applied for grading of cellular rejection. In five patients, there were one or two episodes of biopsy proven acute rejection, grade II or IIIA without any clinical symptoms of rejection. Immediate "pulse therapy" was performed and follow-up biopsies were done. All episodes of rejection were cleared in subsequent biopsies. All patients are doing well without evidence of cardiac problem. The postoperative monitoring of acute rejection is critical since clinical signs of rejection are usually absent. At present, EMB is regarded as the most reliable method for diagnosis and grading of acute rejection and is an efficient guide to the monitoring of the cardiac recipients. Our experience of post-transplantation EMB corresponds with previously published reports.

Case Report

Giant Cell Myocarditis: A case report.: Ho Jung Lee, Jae Gul Chung, In Chul Lee, Myeong Gun Song, Jae Jung Kim, Jong Goo Lee; Korean J Pathol. 1996;30(6):523-527.

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Abstract PDF: Giant cell myocarditis(GCM) is a rare inflammatory heart disease which is characterized by multinucleated giant cells and a granulomatous reaction. It usually progresses rapidly and results in a fatal course. We report a patient with giant cell myocarditis who was treated by cardiac transplantation. A 35-year-old male was admitted with dyspnea which had developed 4 months before. On echocardiography, the right and left ventricles were markedly dilated and severe global hypokinesia was noted. He was diagosed with dilated cardiomyopathy with secondary severe mitral regurgitation. His cardiac function deteriorated progressively. He underwent orthotopic heart transplantation. Grossly the heart was enlarged, weighing 420gm and round with a blunt apex. Both right and left ventricles were markedly dilated. There were numerous white patches, measuring up to 4cm, throughout the epi- and myocardium. Microscopically, extensive fibrosis and multiple exuberant granulomas with numerous scattered multinucleated giant cells were seen. Lymphocytes and eosinophils were also frequent. Coronary arteries were unremarkable. Neither microorganisms nor foreign materials were found. By serial endomyocardial biopsies of the transplanted heart, only mild perivascular lymphocytic infiltration was occasionally observed without any evidence of rejection or recurrence of giant cell myocarditis. The patient's postoperative course has been uneventful so far(postoperative 21 months). The etiology of GCM remains to be clarified, although various factors are suspected. No matter what the cause, our experience suggests that this grave disease might be treated well by heart transplantation.

Original Article

Pathologic Analysis of Endomyocardial Biopsies in Heart Transplantation.: Mee Hye Oh, Jeong Wook Seo, Kook Yang Park, Young Tak Lee, Yoon Seop Jeong, Suk Keun Hong, Joon Ryang Rho, Byung Hee Oh, Sung Sook Kim; Korean J Pathol. 1998;32(2):104-114.

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Abstract PDF: Endomyocardial biopsy (EMB) is a valuable diagnostic procedure for the surveillance of cardiac allograft rejection. Interpretation of individual cases is still problematic due to variations of findings for grading of rejection and other associated lesions. We reevaluated an experience on endomyocardial biopsies to develop better diagnostic criteria for rejection and other complications. Immunohistochemical studies against cytokines were performed to assess the usefulness of the method for the diagnosis or researches. A total of 249 EMBs taken from 33 cardiac allograft recipients were reviewed. There were 25 males and 8 females. Dilated cardiomyopathy was present (24 cases) and valvular heart disease (4 cases), restrictive cardiomyopathy (3 cases) were also common conditions. We applied the grading system of the International Society for Heart Transplantation (ISHT) for the assessment of acute cellular rejection. Grades of 0, 1A, 1B, 2, 3A and 3B were 39.0%, 28.1%, 11.2%, 11.5%, 12.4% and 1.6% respectively, but 3.2% were inadequate. Thirty five episodes of grade 3A or 3B were present in 17 patients. The response to therapy was assessed using a next follow up biopsy, which revealed resolving or resolved rejection in 85% of patients. The intensity of immunohistochemical stains for IL-6 and TNF-alpha was increased in proportion to the histologic grade but Quilty lesion and cardiomyopathy also showed a positive reaction. The other pathologic findings were ischemic change, previous biopsy site, interstitial edema and fibrosis, and Quilty lesion. These findings showed usefulness of endomyocardial biopsy not only for the evaluation of cardiac allograft rejection but also for the diagnosis of associated cardiac lesions. Immunohistochemical study of the cytokines was related to the degree of inflammation rather than degree of rejection.

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