Chronic rejection preceded by central perivenulitis, rapidly ensuing after liver transplantation in a pediatric patient

Tamir Miloh, Margret S. Magid, Kishore Iyer, Nanda Kerkar, Raffaella A. Morotti

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

A 15-year-old boy who underwent liver transplantation for fulminant Wilson's disease, presented with elevated transaminases 2 months post-transplant. He had recently seroconverted from previous Epstein-Barr virus (EBV) naive status and by polymerase chain reaction (PCR) had increasing viral load copies of EBV in blood. A liver biopsy was obtained 6 weeks post-transplant, which showed isolated central perivenulitis (CP). His immunosuppresion was reduced and antiviral therapy was added with subsequent increase in liver transaminases. A second liver biopsy 6 weeks later again showed isolated CP. Subsequent further reduction in immunosuppression was followed by the appearance of portal-based moderate acute cellular rejection that was resistant to immunosuppressive treatment and rapidly evolved into ductopenic chronic rejection. This case report underlines the difficulties in interpreting isolated perivenulitis, especially in the setting of EBV seroconversion, and suggests that it may not only represent a form of acute rejection but also a predictor of rapidly progressing chronic rejection.

Original languageEnglish (US)
Pages (from-to)134-138
Number of pages5
JournalSeminars in liver disease
Volume29
Issue number1
DOIs
StatePublished - Feb 2009
Externally publishedYes

Keywords

  • Chronic rejection
  • Ebv hepatitis
  • Isolated central perivenulitis
  • Liver transplantation
  • Pediatric

ASJC Scopus subject areas

  • Hepatology

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