Allograft liver biopsy in patients with Epstein-Barr virus-associated posttransplant lymphoproliferative disease

Parmjeet Randhawa, K. Blakolmer, Randeep Kashyap, Radmila Raikow, Michael Nalesnik, A. J. Demetris, Ashokkumar Jain

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Abstract

Allograft liver biopsy specimens (n = 24) obtained in the clinical setting of primarily extrahepatic posttransplant lymphoproliferative disease (PTLD) were studied for histopathology, lymphocyte subsets, and Epstein-Barr virus (EBV)encoded EBER RNA. Acute rejection was found in 20 (83.3%) of 24 biopsy specimens and graded as indeterminate in 7 (35%) of 20 (35%), mild in 3 (15%) of 20, and moderate in 10 (50%) of 20 cases. EBV hepatitis was the primary, diagnosis in two biopsy specimens and a secondary finding in six others, Four biopsy specimens showed nonspecific reactive hepatitis, and five showed recurrence of primary liver disease. Immunoperoxidase staining showed primarily T cells. EBER RNA was detected in 14 (58.3%) of 24 biopsy specimens: 12 (60%) of 20 with and 2 (50%) of 4 without acute rejection. Antirejection therapy resulted in complete or partial response in 4 (36.3%) of 11 and 7 (63.7%) of 11 treated cases, respectively, despite the presence of EgV-infected cells in some tissues. Subsequent follow-up showed early or late chronic rejection in 6 (25%) of 24 patients. Gamma glutamyl transferase, a marker for early or late chronic rejection, was greater than five times the upper limit of normal in 9 (37.5%) of 24 patients. In conclusion, liver biopsy specimens in patients with PTLD show a spectrum of pathologic changes. Rejection may be treated even if EBV is concurrently present. Long-term graft is suboptimal, because low immunosuppression results in a tendency to develop chronic rejection.

Original languageEnglish (US)
Pages (from-to)324-330
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume25
Issue number3
DOIs
StatePublished - Mar 6 2001

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Human Herpesvirus 4
Allografts
Biopsy
Liver
Immunosuppression
Hepatitis
RNA
Lymphocyte Subsets
Transferases
Liver Diseases
Staining and Labeling
T-Lymphocytes
Transplants
Recurrence

All Science Journal Classification (ASJC) codes

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Randhawa, Parmjeet ; Blakolmer, K. ; Kashyap, Randeep ; Raikow, Radmila ; Nalesnik, Michael ; Demetris, A. J. ; Jain, Ashokkumar. / Allograft liver biopsy in patients with Epstein-Barr virus-associated posttransplant lymphoproliferative disease. In: American Journal of Surgical Pathology. 2001 ; Vol. 25, No. 3. pp. 324-330.
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abstract = "Allograft liver biopsy specimens (n = 24) obtained in the clinical setting of primarily extrahepatic posttransplant lymphoproliferative disease (PTLD) were studied for histopathology, lymphocyte subsets, and Epstein-Barr virus (EBV)encoded EBER RNA. Acute rejection was found in 20 (83.3{\%}) of 24 biopsy specimens and graded as indeterminate in 7 (35{\%}) of 20 (35{\%}), mild in 3 (15{\%}) of 20, and moderate in 10 (50{\%}) of 20 cases. EBV hepatitis was the primary, diagnosis in two biopsy specimens and a secondary finding in six others, Four biopsy specimens showed nonspecific reactive hepatitis, and five showed recurrence of primary liver disease. Immunoperoxidase staining showed primarily T cells. EBER RNA was detected in 14 (58.3{\%}) of 24 biopsy specimens: 12 (60{\%}) of 20 with and 2 (50{\%}) of 4 without acute rejection. Antirejection therapy resulted in complete or partial response in 4 (36.3{\%}) of 11 and 7 (63.7{\%}) of 11 treated cases, respectively, despite the presence of EgV-infected cells in some tissues. Subsequent follow-up showed early or late chronic rejection in 6 (25{\%}) of 24 patients. Gamma glutamyl transferase, a marker for early or late chronic rejection, was greater than five times the upper limit of normal in 9 (37.5{\%}) of 24 patients. In conclusion, liver biopsy specimens in patients with PTLD show a spectrum of pathologic changes. Rejection may be treated even if EBV is concurrently present. Long-term graft is suboptimal, because low immunosuppression results in a tendency to develop chronic rejection.",
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Allograft liver biopsy in patients with Epstein-Barr virus-associated posttransplant lymphoproliferative disease. / Randhawa, Parmjeet; Blakolmer, K.; Kashyap, Randeep; Raikow, Radmila; Nalesnik, Michael; Demetris, A. J.; Jain, Ashokkumar.

In: American Journal of Surgical Pathology, Vol. 25, No. 3, 06.03.2001, p. 324-330.

Research output: Contribution to journalArticle

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AU - Randhawa, Parmjeet

AU - Blakolmer, K.

AU - Kashyap, Randeep

AU - Raikow, Radmila

AU - Nalesnik, Michael

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N2 - Allograft liver biopsy specimens (n = 24) obtained in the clinical setting of primarily extrahepatic posttransplant lymphoproliferative disease (PTLD) were studied for histopathology, lymphocyte subsets, and Epstein-Barr virus (EBV)encoded EBER RNA. Acute rejection was found in 20 (83.3%) of 24 biopsy specimens and graded as indeterminate in 7 (35%) of 20 (35%), mild in 3 (15%) of 20, and moderate in 10 (50%) of 20 cases. EBV hepatitis was the primary, diagnosis in two biopsy specimens and a secondary finding in six others, Four biopsy specimens showed nonspecific reactive hepatitis, and five showed recurrence of primary liver disease. Immunoperoxidase staining showed primarily T cells. EBER RNA was detected in 14 (58.3%) of 24 biopsy specimens: 12 (60%) of 20 with and 2 (50%) of 4 without acute rejection. Antirejection therapy resulted in complete or partial response in 4 (36.3%) of 11 and 7 (63.7%) of 11 treated cases, respectively, despite the presence of EgV-infected cells in some tissues. Subsequent follow-up showed early or late chronic rejection in 6 (25%) of 24 patients. Gamma glutamyl transferase, a marker for early or late chronic rejection, was greater than five times the upper limit of normal in 9 (37.5%) of 24 patients. In conclusion, liver biopsy specimens in patients with PTLD show a spectrum of pathologic changes. Rejection may be treated even if EBV is concurrently present. Long-term graft is suboptimal, because low immunosuppression results in a tendency to develop chronic rejection.

AB - Allograft liver biopsy specimens (n = 24) obtained in the clinical setting of primarily extrahepatic posttransplant lymphoproliferative disease (PTLD) were studied for histopathology, lymphocyte subsets, and Epstein-Barr virus (EBV)encoded EBER RNA. Acute rejection was found in 20 (83.3%) of 24 biopsy specimens and graded as indeterminate in 7 (35%) of 20 (35%), mild in 3 (15%) of 20, and moderate in 10 (50%) of 20 cases. EBV hepatitis was the primary, diagnosis in two biopsy specimens and a secondary finding in six others, Four biopsy specimens showed nonspecific reactive hepatitis, and five showed recurrence of primary liver disease. Immunoperoxidase staining showed primarily T cells. EBER RNA was detected in 14 (58.3%) of 24 biopsy specimens: 12 (60%) of 20 with and 2 (50%) of 4 without acute rejection. Antirejection therapy resulted in complete or partial response in 4 (36.3%) of 11 and 7 (63.7%) of 11 treated cases, respectively, despite the presence of EgV-infected cells in some tissues. Subsequent follow-up showed early or late chronic rejection in 6 (25%) of 24 patients. Gamma glutamyl transferase, a marker for early or late chronic rejection, was greater than five times the upper limit of normal in 9 (37.5%) of 24 patients. In conclusion, liver biopsy specimens in patients with PTLD show a spectrum of pathologic changes. Rejection may be treated even if EBV is concurrently present. Long-term graft is suboptimal, because low immunosuppression results in a tendency to develop chronic rejection.

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