4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

Clinical Cytology - Plenary and Invited Lectures
C4D IN PATIENTS WITH ACUTE REJECTION AND/OR HEPATITIS C RECURRENCE
AFTER LIVER TRANSPLANTATION- SINGLE CENTER EXPERIENCE.
Gašparov S1 , Buhin M2 , Filipec-Kanižaj T3 , Kocman B2 , Škrtić A1 1 Department of Clinical Pathology and Cytology
2 Department of Surgery, Division of Transplantation Surgery
3 Department of Medicine 3 Merkur University Hospital - Zagreb, Croatia
Hepatitis C (HCV) induced cirrhosis is one of the most common indication for liver transplantation
(LTX). Updated data suggest worse long-term outcomes for those transplanted
with HCV than those transplanted for other indications. Re-infection with HCV following
LTX is almost universal. The differentiation between acute cellular rejection (ACR)
and recurrent HCV is very important as rejection treatments are likely to aggravate HCV
recurrence. Many autors advocate/suggest restricted use of steroid treatment even in
cases of validated rejection. Liver biopsy represents the gold standard for the diagnosis
of both ACR and HCV reinfection. Nevertheless, discrimination can be very difficult due
to quite similar morphological pictures.
C4d is an end-product of the activated classical complement cascade typically detectable
not only in infection and autoimmune disorders but also in early humoral rejection.
According to some autors C4d can be detected in hepatic specimen in ACR after LTX.
It is still matter of debate whether C4d may serve as a specific marker for differential
diagnosis ACR in HCV reinfection cases.
We performed retrospective analysis of 58 liver biopsies from liver transplanted patients
who had either ACR (N=29) or HCV reinfection (n=19). Patients with no pathological
alterations (n=10) served as control group. In most cases underlying diseases requiring
LTX in group with ACR as well as in the group without morphological changes was
alcohol-induced cirrhosis. Specimens were taken due to the suspicion of ACR and HCV
reinfection according to clinical and laboratory findings or as standard protocol biopsies.
Immunohistochemical analysis for C4d was performed.
A total of 72,4 % of ACR samples (21/29) were positive for C4d whereas 26,3 % HCV recurrence
samples (5/19) showed C4d positive staining. There was no immunohistochemical
positivity for Cd4 in control group samples. Our results suggest that C4d may be
indeed helpful in distinguishing ACR and HCV reinfection after LTX.
gasparovslavko@yahoo.com
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4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology