Vij M, Rammohan A, Rela M. Long-term liver allograft fibrosis: A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection. World J Hepatol 2022; 14(8): 1541-1549 [PMID: 36157865 DOI: 10.4254/wjh.v14.i8.1541]
Corresponding Author of This Article
Mukul Vij, MD, Department of Pathology, Dr. Rela Institute and Medical Center, No. 7 ClC Works Road, Nagappa Nagar, Chromepet, Chennai 600044, Tamil Nadu, India. mukul.vij.path@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Hepatol. Aug 27, 2022; 14(8): 1541-1549 Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1541
Long-term liver allograft fibrosis: A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection
Mukul Vij, Ashwin Rammohan, Mohamed Rela
Mukul Vij, Department of Pathology, Dr. Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
Ashwin Rammohan, Mohamed Rela, Institute of Liver disease and Transplantation, Dr. Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
Author contributions: Vij M and Rammohan A conceptualized the review, performed literature search, and drafted the manuscript; Rela M edited and revised the review; all authors read and approved the manuscript for publication.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mukul Vij, MD, Department of Pathology, Dr. Rela Institute and Medical Center, No. 7 ClC Works Road, Nagappa Nagar, Chromepet, Chennai 600044, Tamil Nadu, India. mukul.vij.path@gmail.com
Received: November 9, 2021 Peer-review started: November 9, 2021 First decision: May 31, 2022 Revised: July 8, 2022 Accepted: August 15, 2022 Article in press: August 15, 2022 Published online: August 27, 2022
Abstract
Liver transplantation (LT) is a life-saving surgical procedure and the current standard of care for most patients with end stage liver disease. With improvements in organ preservation techniques, perioperative care, and immunosuppression, there is better patient and graft survival following LT, and assessment of the liver allograft in long-term survivors is becoming increasingly important. Recurrent or de novo viral or autoimmune injury remains the most common causes of chronic hepatitis and fibrosis following liver transplantation in adults. However, no obvious cause can be identified in many adults with controlled recurrent disease and the majority of pediatric LT recipients, as they have been transplanted for non-recurrent liver diseases. Serial surveillance liver biopsies post LT have been evaluated in several adult and pediatric centers to identify long-term pathological changes. Pathological findings are frequently present in liver biopsies obtained after a year post LT. The significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry parameters. This narrative review summaries the factors predisposing to long-term liver allograft fibrosis, highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.
Core Tip: Pathological findings are frequently present in liver biopsies obtained after a year post LT. The significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry parameters. This narrative review summaries the factors predisposing to long-term liver allograft fibrosis, highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.
