Hepatotoxicity with ductopenia
and cholestasis has occurred in patients treated with TURALIO.
and apoptosis of small- to medium-caliber bile duct epithelial cells are histopathological lesions that result from the activation of pro-inflammatory cytokines (35).
TAC had to be withdrawn at day 28 owing to severe neurologic symptoms; however ductopenia
appeared in the liver biopsy over 6 months later and the patient was treated with methylprednisolone, mTOR, and reintroduction of TAC.
The sampled portal tracts showed the appropriate constellation of artery, vein, and interlobular bile duct without evidence of ductopenia
. The inflammation was not centered on the portal tracts and the bile ducts themselves showed no obvious intraepithelial infiltrate or reactive-type epithelial changes.
Cholestatic liver disease with ductopenia
(vanishing bile duct syndrome) in Hodgkin's disease: Report of a case.
The authors reported that diffuse portal C4d deposition, together with DSA positivity in the serum, predicted the frequency of acute rejection episodes, as well as the likelihood of steroid-resistant rejection and ductopenia
. Taken together, these observations suggest that humoral alloreactivity is closely intertwined with cellular mechanisms during acute rejection; alloantibodies may be a direct consequence of cell-mediated immunity, but antibodies may in turn intensify the degree of tissue injury.
Liver biopsy showed mixed inflammatory infiltrate with eosinophils and no presence offibrosis or ductopenia
similar to other biopsies reported in two cases by Russmann et al.
Histologically, the liver biopsy reveals a chronic necroinflammatory disorder characterized by nonspecific findings such as portal mononuclear cell infiltrate, periportal lesion (sometimes referred to as piecemeal necrosis or interface hepatitis), bile duct changes, destructive, and non destructive cholangitis and ductopenia
present in 25% of patients, plasma cell infiltrate and liver fibrosis.
The portal tracts were expanded by dense lymphocytic infiltrate and diminished bile ducts (ductopenia
) were seen.
The panel also selected incompatible histologic features, such as cholestasis, evidence of bile duct injury, and ductopenia
Idiopathic adulthood ductopenia
(IAD), for the first time, was reported in 1988 .
Some useful clues that favor acute cellular rejection include a mixed portal inflammatory infiltrate with eosinophils, bile duct damage that is more diffuse and severe than expected in chronic hepatitis, possible ductopenia
, central perivenulitis that involves majority of central veins and less lobular necroinflammatory activity and interface activity24.