Isolated vascular "v" lesions in liver allografts: How to approach this unusual finding.

Heather Stevenson, Mariana M. Prats, Kumiko Isse, Adriana Zeevi, avitzur A, Vicky Lee Ng, A. J. Demetris

Research output: Contribution to journalArticle

Abstract

According to the Banff criteria for kidney allografts, isolated vascular or "v" lesions are defined as intimal inflammation, age-inappropriate fibro-intimal hyperplasia, or both, without the presence of associated interstitial T cell-mediated rejection (TCMR). In general, these lesions portend a worse outcome for kidney allografts, particularly in those where the "v" lesions are identified in patients with coexistent donor specific antibodies (DSA) or later after transplantation. Although affected arteries are rarely sampled in liver allograft biopsies, we identified nine patients at a mean of 1805 days posttransplantation and compared these to matched controls. Almost half (4 of 9) of the study patient biopsies showed inflammatory arteritis associated with focal or diffuse C4d positivity, which was not observed in matched controls. One "v" lesion patient progressed to rejection-related graft failure and two developed moderate/severe TCMR in subsequent biopsies, whereas only one rejection episode occurred in follow-up biopsies, and no rejection-related deaths or graft failures were detected in controls. In conclusion, patients with liver allograft isolated "v" lesions should undergo further evaluation and closer follow-up for impending TCMR and/or underlying co-existent chronic antibody-mediated rejection (AMR).
Original languageEnglish (US)
JournalAmerican Journal of Transplantation
StatePublished - 2018

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Allografts
Blood Vessels
Liver
Tunica Intima
Biopsy
T-Lymphocytes
Kidney
Arteritis
Antibodies
Graft Rejection
Hyperplasia
Arteries
Transplantation
Tissue Donors
Inflammation
Transplants

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Isolated vascular "v" lesions in liver allografts: How to approach this unusual finding. / Stevenson, Heather; Prats, Mariana M.; Isse, Kumiko; Zeevi, Adriana; A, avitzur; Ng, Vicky Lee; Demetris, A. J.

In: American Journal of Transplantation, 2018.

Research output: Contribution to journalArticle

Stevenson, Heather ; Prats, Mariana M. ; Isse, Kumiko ; Zeevi, Adriana ; A, avitzur ; Ng, Vicky Lee ; Demetris, A. J. / Isolated vascular "v" lesions in liver allografts: How to approach this unusual finding. In: American Journal of Transplantation. 2018.
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AU - Stevenson, Heather

AU - Prats, Mariana M.

AU - Isse, Kumiko

AU - Zeevi, Adriana

AU - A, avitzur

AU - Ng, Vicky Lee

AU - Demetris, A. J.

PY - 2018

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AB - According to the Banff criteria for kidney allografts, isolated vascular or "v" lesions are defined as intimal inflammation, age-inappropriate fibro-intimal hyperplasia, or both, without the presence of associated interstitial T cell-mediated rejection (TCMR). In general, these lesions portend a worse outcome for kidney allografts, particularly in those where the "v" lesions are identified in patients with coexistent donor specific antibodies (DSA) or later after transplantation. Although affected arteries are rarely sampled in liver allograft biopsies, we identified nine patients at a mean of 1805 days posttransplantation and compared these to matched controls. Almost half (4 of 9) of the study patient biopsies showed inflammatory arteritis associated with focal or diffuse C4d positivity, which was not observed in matched controls. One "v" lesion patient progressed to rejection-related graft failure and two developed moderate/severe TCMR in subsequent biopsies, whereas only one rejection episode occurred in follow-up biopsies, and no rejection-related deaths or graft failures were detected in controls. In conclusion, patients with liver allograft isolated "v" lesions should undergo further evaluation and closer follow-up for impending TCMR and/or underlying co-existent chronic antibody-mediated rejection (AMR).

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