Loss of bile ducts is a characteristic feature of chronic rejection in the liver allograft (also known as irreversible rejection and vanishing @entity1157 ). Typically, this occurs as a progressive lesion resulting in irreversible damage and graft failure requiring retransplantation. In this study, we describe 6 @entity1 who developed a transient loss of bile ducts following liver transplantation. This occurred in a series of 138 @entity1 who underwent the first 160 liver transplant operations in the Birmingham Liver Transplant Programme (incidence = 4.4% of @entity1 , 3.7% of grafts). Forty needle biopsies were obtained from the 6 @entity1 between 6 and 1303 days after transplantation. Thirteen specimens, taken between 8 and 1253 days posttransplant (median 98 days) showed an absence of bile ducts in more than 50% of portal tracts. Other histologic features of chronic rejection, inflammatory bile-duct lesions, perivenular @entity1448 , and hepatocyte dropout were also seen in these biopsies, and severe @entity1448 was present biochemically (median serum @entity648 level 240 mumol/L). The histologic and biochemical changes were thought to be compatible with a diagnosis of chronic/irreversible rejection, but the decision to carry out retransplantation was deferred on the basis of stable and, subsequently, improving biochemistry. Follow-up biopsies showed recovery of duct loss and other histologic abnormalities. All 6 @entity1 are currently alive and well with good graft function. It is concluded that a transient, reversible bile-duct loss can occur after liver transplantation and that cases with this condition are indistinguishable from those who subsequently develop irreversible graft damage. In view of the risks associated with additional immunosuppression and/or retransplantation, caution is advocated in the interpretation of ductopenia in posttransplant liver biopsies. We suggest that the term "early chronic rejection" might be appropriate to describe cases in which a definite diagnosis of irreversible graft damage cannot be made.

XXXX following liver transplantation--is it reversible?

@entity1 :: ('9606', 'Species') :: ['patients'] @entity1157 :: ('MESH:D001649', 'Disease') :: ['bile-duct syndrome'] @entity648 :: ('MESH:D001663', 'Chemical') :: ['bilirubin'] @entity1448 :: ('MESH:D002779', 'Disease') :: ['cholestasis']
@entity1157 :: (MESH:D001649,Disease) :: ['Vanishing bile-duct syndrome']
