Recurrent hepatitis C virus after transplant and the importance of plasma cells on biopsy

Table 1 Generalized histologic and clinical features seen in post transplant patients with hepatitis C

Pathologic entity	Histologic features	Clinical and laboratory features
Plasma cell hepatitis	Plasma cells (often in sheets) Centrilobular necrosis	HCV PCR positive ANA or ASMA may be positive (often with low titers) Low level of immunosuppression Can be caused by interferon based therapy
De novo autoimmune hepatitis	Lymphoplasmacytic infiltrate Interface hepatitis	Positive ANA or ASMA Elevated immunoglobulins In persons on treatment HCV RNA often not detected (occurs in other settings in addition to HCV) Low level of immunosuppression Can be caused by interferon based therapy
Acute cellular rejection	Mixed inflammatory infiltrate Endotheliitis Nonsuppurative Cholangitis Centrilobular necrosis (variable)	Low level of immunosuppression Can be caused by interferon based therapy
Recurrent hepatitis C	Lymphocyte Aggregates Portal based fibrosis FCH is one variant (Cholestasis, Apoptosis, Fibrosis)	HCV PCR positive In FCH, markedly high viral load In FCH, high level of immunosuppression

HCV: Hepatitis C virus; FCH: Fibrosingcholestatic hepatitis; ANA: Antinuclear antibodies; ASMA: Anti-smooth muscle antibody; PCR: Polymerase chain reaction.