Chronic rejection after liver transplantation: Opening the Pandora’s box

Table 2 Histological features of early and late chronic T cell-mediated rejection according to the Banff schema[2]

Structure	Early CR	Late CR
Small bile ducts (< 60 μm)	(1) Degenerative changes involving the majority of ducts: Eosinophilic transformation of the cytoplasm; Increased nucleus: Cytoplasm ratio; nuclear hyperchromasia; uneven nuclear spacing; ducts only partially lined by biliary epithelial cells; and (2) Bile duct loss in < 50% of the portal tracts	(1) Degenerative changes in remaining bile ducts; and (2) Loss in > 50% of the portal tracts
Terminal hepatic venules and zone 3 hepatocytes	(1) Intimal/luminal inflammation; (2) Lytic zone 3 necrosis and inflammation; and (3) Mild perivenular fibrosis	(1) Focal obliteration; (2) Variable inflammation; and (3) Severe (bridging) fibrosis
Portal tract hepatic arterioles	Occasional loss involving < 25% of the portal tracts	Loss involving > 25% of the portal tracts
Other	So-called "transition" hepatitis with spotty necrosis of hepatocytes	Sinusoidal foam cell accumulation and marked cholestasis
Large perihilar hepatic artery branches	Intimal inflammation and focal foam cell deposition without luminal compromise	(1) Luminal narrowing by subintimal foam cells; and (2) Fibrointimal proliferation
Large perihilar bile ducts	Inflammation damage and focal foam cell deposition	Mural fibrosis

CR: Chronic rejection.