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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Sinusoidal endotheliitis as a histological parameter for diagnosing acute liver allograft rejection
Yu Shi, Kun Dong, Yu-Guo Zhang, René P Michel, Victoria Marcus, Yu-Yue Wang, Yu Chen, Zu-Hua Gao
Yu Shi, René P Michel, Victoria Marcus, Yu-Yue Wang, Zu-Hua Gao, Department of Pathology, McGill University, Montreal, Quebec QCH3A0G4, Canada
Yu Shi, Yu Chen, Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick E3B 5N5, Canada
Kun Dong, Department of Pathology, Beijing YouAn Hospital, Capital Medical University, Beijing 100054, China
Yu-Guo Zhang, Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Shi Y and Dong K contributed equally to the manuscript in study design, case review and selection, acquisition, analysis, and interpretation of data; Shi Y contributed to manuscript writing; Zhang YG contributed to additional data collection, case review, and interpretation; Gao ZH contributed to conception, design of the study, and manuscript revision; all other authors made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Institutional review board statement: The study was reviewed and approved by institutional review board (IRB) at McGill University. All routine liver biopsy specimens from the patients were taken after informed consent and ethical permission was obtained for this retrospective study.
Conflict-of-interest statement: The authors have no potential conflicts of interest to disclose.
Data sharing statement: Dataset available from the corresponding author at Zu-hua.gao@mcgill.ca.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zu-Hua Gao, MD, PhD, FRCPC, Department of Pathology, McGill University, Rm E04.1820, 1001 Decarie Boulevard, Montreal, Quebec QCH3A0G4, Canada.
zu-hua.gao@mcgill.ca
Telephone: +1-514-9341934 Fax: +1-514-9348296
Received: October 16, 2016
Peer-review started: October 18, 2016
First decision: November 21, 2016
Revised: December 18, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 7, 2017
Processing time: 98 Days and 0.1 Hours
AIM
To investigated the feasibility of using sinusoidal endotheliitis (SE) as a histological marker for liver allograft rejection.
METHODS
We compared the histological features of 88 liver allograft biopsies with acute cellular rejection (ACR) and 59 cases with no evidence of ACR. SE was scored as: (1) focal linear lifting up of the endothelial cells by lymphocytes with no obvious damage to adjacent hepatocytes; (2) focal disruption of the endothelial lining by a cluster of subendothelial lymphocytes (a group of > 3 lymphocytes); and (3) severe confluent endotheliitis with hemorrhage and adjacent hepatocyte loss.
RESULTS
The sensitivity and specificity of SE was 81% and 85%, respectively. Using SE as the only parameter, the positive predictive value for ACR (PPV) was 0.89, whereas the negative predictive value for ACR (NPV) was 0.75. The correlation between RAI and SE was moderate (R = 0.44, P < 0.001) (Figure 3A), whereas it became strong (R = 0.65, P < 0.001) when correlating SE with the venous endotheliitis activity index only.
CONCLUSION
Our data suggest that SE scoring could be a reliable and reproducible supplemental parameter to the existing Banff schema for diagnosing acute liver allograft rejection.
Core tip: In this clinico-pathological study, we have found that scoring of the sinusoidal endotheliitis could be a reliable and practically reproducible supplemental parameter to the existing Banff schema for diagnosing early acute cellular rejection in liver allograft as well as predicting the occurrence of acute cellular rejection in appropriate clinical setting.
