Abstract
Hepatic angiosarcoma is a rare tumour that is often difficult to diagnose. Historically, most cases of hepatic angiosarcoma were seen in the setting of industrial epidemics caused by exposure of workers to toxins such as vinyl chloride. Cases associated with recognised exposure to carcinogens have fortunately been extremely rare for the last three or more decades. However, the tumour has by no means disappeared in the Australian community. In this case series, we describe three cases of hepatic angiosarcoma that were seen at our institution since 2002. The first case presented with cholestatic liver function tests and was found to have angiosarcoma on liver biopsy. In the second case, the patient was admitted for decompensated liver disease on a background of presumed hepatitis B cirrhosis. The diagnosis of hepatic angiosarcoma was made only at autopsy after the patient died from multi-organ failure. The third case presented with ascites and the diagnosis of disseminated angiosarcoma was again made at autopsy following a negative ante-mortem liver biopsy.
Abstract
Hepatic angiosarcoma is a rare tumour that is often difficult to diagnose. Historically, most cases of hepatic angiosarcoma were seen in the setting of industrial epidemics caused by exposure of workers to toxins such as vinyl chloride. Cases associated with recognised exposure to carcinogens have fortunately been extremely rare for the last three or more decades. However, the tumour has by no means disappeared in the Australian community. In this case series, we describe three cases of hepatic angiosarcoma that were seen at our institution since 2002. The first case presented with cholestatic liver function tests and was found to have angiosarcoma on liver biopsy. In the second case, the patient was admitted for decompensated liver disease on a background of presumed hepatitis B cirrhosis. The diagnosis of hepatic angiosarcoma was made only at autopsy after the patient died from multi-organ failure. The third case presented with ascites and the diagnosis of disseminated angiosarcoma was again made at autopsy following a negative ante-mortem liver biopsy.
Mark Haas Kidney Summary Banff 2013 in Brazil Kim Solez ,
Kidney summary from 12th Banff Conference on Transplant Pathology from the meeting in Comandatuba-Bahia, Brazil on August 23rd, 2013 http://cybernephrology.ualberta.ca/banff/2013
Graft-versus-host disease (GVHD) is a complication seen in allogeneic stem cell transplantation. The incidence and severity is more in T-cell replete allograft (stem cells), donor T-cells being the principal mediators of GVHD. Acute GVHD is seen within 90 days post transplant and chronic GVHD after 90 days. Cyclosporin A (CsA) and methotrexate combination is used in prevention of acute GVHD. Corticosteroids and CsA combination is used in treatment of both acute and chronic GVHD.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Antibody mediated rejection of solid organ allograftstashagarwal
Objectives:
Introduction of Antibody mediated rejection AMR
Role of C4d in transplant rejection
Donor specific antibodies DSA
Presentation of AMR in kidney, liver, lung and heart.
Mark Haas Kidney Summary Banff 2013 in Brazil Kim Solez ,
Kidney summary from 12th Banff Conference on Transplant Pathology from the meeting in Comandatuba-Bahia, Brazil on August 23rd, 2013 http://cybernephrology.ualberta.ca/banff/2013
Graft-versus-host disease (GVHD) is a complication seen in allogeneic stem cell transplantation. The incidence and severity is more in T-cell replete allograft (stem cells), donor T-cells being the principal mediators of GVHD. Acute GVHD is seen within 90 days post transplant and chronic GVHD after 90 days. Cyclosporin A (CsA) and methotrexate combination is used in prevention of acute GVHD. Corticosteroids and CsA combination is used in treatment of both acute and chronic GVHD.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Antibody mediated rejection of solid organ allograftstashagarwal
Objectives:
Introduction of Antibody mediated rejection AMR
Role of C4d in transplant rejection
Donor specific antibodies DSA
Presentation of AMR in kidney, liver, lung and heart.
Pancreas summary from 12th Banff Conference on Transplant Pathology from the meeting in Comandatuba-Bahia, Brazil on August 23rd, 2013 http://cybernephrology.ualberta.ca/banff/2013
Overcoming the challenges of molecular diagnostics in government health insti...Yakubu Sunday Bot
overcoming the challenges of molecular diagnostics in government owned health institution in nigeria.Several challenges abound in the Nigerian health sector ranging from financial,political and lack of commitment.Its obvious and no wonder the state of health care deliveryy, vis a vis its quality of care to its citizenry.
Optimizing antimicrobial therapy for hospitalized pneumonia: Focus on PK/PD p...WAidid
Professor Blasi slideset is about the optimization of antimicrobial therapy for pneumonia and it underlines how the appropriate early antibiotic therapy reduces mortality rates in patients with bloodstream infection.
01 Presentation I VS (8-55MB)- (3-28-08).ppsvshidham
Part I of Four part symposium: “Diagnostic Cytopathology of Serous Effusion” on April 19, 2007 at Neenah, WI, USA
(2008 Wisconsin Society of Cytology, 40th Anniversary)
Similar to banff2015 liver session summary- bellamy-2 (20)
Slide deck for annual meeting of Transplant Regenerative medicine Community of Practice of American Society of Transplantation at noon in Room 204 in John B. Hynes Convention Center. Everyone welcome! Many exciting initiatives to discuss!
Kim Solez Xenotransplantation- The Rest of the Story April 8 2022 6.pptxKim Solez ,
Nephrology Grand Rounds Presentation at the University of Alberta discussing the big picture issues surrounding xenotransplantation and its relation to stem cell generated organs and bioengineered organs in the future
Kim Solez Hooking-Up Physical Forces Optimism and Dark Energy Presentation Se...Kim Solez ,
Kim Solez Banff New Media Institute Presentation, "Smart, Sexy, Healthy" ThinkTank, Sept 6 2001
Hooking-Up, Physical Forces, Optimism and Dark Energy: Imagery, Hope, and Health.
Kim Solez 384 years of banff spirit new june 26 2019Kim Solez ,
Kim Solez 384 years of Banff spirit new June 26 2019 The most remarkable slide is number 137. "By Spring of 2019 every erroneous statement we complained about had been reversed. We celebrated by creating a new video trailer on our YouTube channel on June 25 2019." How about that!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
1. Banff 2015 – Liver
Agenda and Background
A.J. Demetris
Thomas Starzl Transplant Institute
Dept. of Pathology
Division of Transplantation
University of Pittsburgh Medical Center
Pittsburgh, PA
2. Goals of Meeting
• Discuss role of antibodies in OLTx:
– effector and ? other functions
• Discuss what is needed to establish a
diagnosis of antibody-mediated rejection
(AMR) in OLTx:
– Acute (or active) AMR
– Chronic AMR
• Agree on criteria and make
recommendations to the field.
3. EOSINOPHIL AND NK CELLS
IN ADCC AND LIVER INJURY
Luis G. Hidalgo, Ph.D., D(ABHI)
University of Alberta Hospitals –
Histocompatibility Laboratory
Dept. of Lab. Med. and Pathology
Alberta Transplant Applied Genomics Centre
6. Liver Allograft Pathology After
Effective Anti-HCV Therapies -
Changes and Challenges
Professor G.W. McCaughan
A/W Morrow Professor of Gastroenterology and Hepatology
ANLTU
University of Sydney
Centenary Institute
Royal Prince Alfred Hospital
Sydney, Australia
7. • Interferon free DAA AVT will largely reduce HCV
infection in the liver allograft but may only
prevent liver transplant in a minority
• However post transplant a small number of cases
will require astute liver biopsy and histological
assessment These include
– AVT resistance cases ( G3 at the moment)
– DILI
– Allograft rejection ( a decrease in Calcineurin inhibitor
levels)
– Immune hepatitis /Immune activation syndrome
9. Participating Centers
• USA
– UPMC
– Childrens hosp of
Pittsburgh
– Mayo
– Mt Sinai
– Kansas
– UCLA
– Mass General
– Baylor
– Medical College of
Wisconsin
– UWHC
– John Hopkins
– Emory
• Canada
– Alberta
• UK
• Birmingham
• Cambridge
• Edinburgh
• Kings
• Leeds
• France
• Paul Brousse
Paris
• Turkey
• Instanbul
• Ege
• Denmark
• Copenhagen
• Norway
• Oslo
• Switzerland
• Basel
• Belgium
• Leuven
• Italy
• Palermo
• Brazil
• Sao Paulo
• Japan
• Kyoto
• Kobe
• Australia
• Sydney
• Brisbane
11. CONCLUSIONS
• Portal veins and capillaries are most sensitive
target structures
– Sinusoids least sensitive and difficult to detect
– Ignore stromal staining (portal and central) in
perihilar areas/large portal tracts
• Variability in C4d staining between centres
– best performing method made available
12. Pathophysiologic Mechanisms of (Late) Liver
Allograft Injury/Fibrosis
Stefan Hübscher,
Institute of Immunology & Immunotherapy, University of Birmingham
Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham
13. Late Centrilobular/Perisinusoidal Fibrosis in Paediatric Liver Allografts
Further Evidence for Antibody- Mediated Mechanisms
(Miyagawa-Hayashino 2012 , Yamada 2012 ,Tomita 2013, Ohe 2014)
• Bridging fibrosis/cirrhosis in protocol biopsies > 5 years post transplant associated
with donor-specific antibodies - mainly class II (Miyagawa-Hayashino 2012, Ohe 2014)
• Pericentral/pericellular fibrosis in protocol biopsies > 1year post-transplant
associated with C4d deposits in portal vessels and hepatic veins (Yamada2012) and
with ABO-incompatibility (Tomita 2013)
• Mild inflammatory changes (portal and/or centrilobular) also present in 60-87%
biopsies showing centrilobular /perisinusoidal fibrosis (Miyagawa-Hayashino 2012,
Yamada 2012)
• Antibody-mediated mechanisms may lead to late
fibrosis with or without inflammation
• Importance of recognising fibrosis in different
regions (portal, sinusoidal, centrilobular)
14. De novo Donor-Specific Antibodies
in Liver Transplantation:
Clinical and Histopathological manifestations
Dr Arnaud DEL BELLO
Department of Nephrology and Organ Transplantation
CHU Toulouse Rangueil
France
15. Incidence of aAMR in de novo liver
transplantation
Del Bello et al, Transplant Int 2015
0
5
10
15
20
25
30
D0
n=152
M1
n=152
M3
n=149
M6
n=144
M12
n=129
M24
n=93
M36
n=70
M48
n=41
Percentageofpatientswithanti-HLA
dnDSAs
Time post liver transplantation (months)
dnDSAs (anti-class I +/- II)
anti-class I dnDSAs
anti-class II dnDSAs
152 LTR:
Follow-up 34 [1.5-77] months
14 % dnDSA+ at last Follow-up
Acute rejections: 52% (dnDSA+) vs.
21% (DSA-), p= 0.005
9 cases of aAMR
(incidence at LFU 5.1%)
16. dnDSA & acute AMR:
graft dysfunction with
1. dnDSA in serum
2. H & E staining
3. C4d positive
4. Exclusion of other causes
17. Long-Term Follow-up and Weaning Immunosuppression in
Pediatric Recipients:
Factors Influencing the Graft
Sandy Feng, MD, PhD
University of California San Francisco
2015 Joint Banff – CST Scientific Meeting
October 7, 2015
Vancouver, BC
18. Observations
• Stable, long-term pediatric liver transplant recipients with
normal liver tests can harbor significant histopathology.
• High MFI Class II DSA is a strong risk factor for interface
hepatitis (± fibrosis) and a modest risk factor for fibrosis.
• Spontaneously / operationally tolerant pediatric liver
transplant recipients do not exhibit progressive allograft
histopathology.
• (High MFI) Class II DSA, present either at baseline or
developing during withdrawal, is not prohibitive of
spontaneous / operational tolerance.
20. Arnaud Del
Bello
Adults
6 – 220
mo.
Indication ↑Fibrosis, NOS
24% of patients with de novo DSA developed acute AMR:
lymphocytic portal inflammation, lymphocytic cholangitis, PV C4d+,
endotheliitis
Sandy Feng Pediatric
> 4 years
Protocol Deceased donor and Class II DSA predicted assignment to patients
with interface activity with/out fibrosis whereas only recipient age
predicted assignment patients with fibrosis, alone.
Jackie O’Leary Adult
> 5 yrs
Protocol ↑ portal inflammation and interface activity
↑ lobular/perivenular inflammation and typical TCMR
↑ portal venopathy, portal “collagenization” and portal/periportal
and sinusoidal fibrosis
DSA strongly correlated with portal capillary and portal stromal
C4d (IPEX)
Histologic changes with chronic DSA
21. Consensus discussion
• Acute AMR
– compatible histology, diffuse C4d portal
microvascular positivity, serum DSA+
– grading of component features
• i-(immune) score: C4d immunopositivity
• h-(histopathology) score
• Probable chronic AMR
– compatible histology, C4d +, recent DSA +,
exclusion of other potential causes
22. i-(immune)-score (FFPE*):
0. No C4d deposition in portal microvasculature
1. Minimal (<10% portal tracts) C4d deposition in
portal microvascular endothelia
2. Moderate (10-50% portal tracts) C4d deposition
in portal microvascular endothelia – usually
without extension into periportal sinusoids
3. Diffuse (>50% portal tracts) C4d deposition in
the portal microvascular endothelia - often
with extension into inlet venules or periportal
sinusoids
23. h-(histopathology) score
• portal microvascular endothelial cell enlargement (portal veins,
capillaries, inlet venules) involving a majority of portal tracts with
sparse microvasculitis (images provided)
• monocytic , eosinophilic or neutrophilic micro-
vasculitis/capillaritis, with prominent portal and/or sinusoidal
microvascular endothelial cell enlargement involving a majority of
portal tracts or sinusoids, with some portal edema, portal
capillary and inlet venule dilatation. Fibrin deposition and RBC
sludging is more common and prominent in ABO-incompatible
allografts.
• As above, with at least focal microvascular disruption with fibrin
deposition, and extravasation of red blood cells into the portal
stroma and/or space of Disse (subsinusoidal space). The latter
findings are more prominent in ABO-incompatible allografts.
24. Probable chronic AMR
(all 4 criteria required):
1) Histopathological pattern of injury consistent with
chronic AMR: both required:
a. Otherwise unexplained and at least mild mononuclear
portal inflammation with interface hepatitis and/or
lymphocytic perivenulitis.
b. At least moderate sinusoidal and/or perivenular fibrosis
2) Recent circulating HLA DSA in serum samples
(for example, measured within 3 months of biopsy)
3) At least focal C4d positivity (>10% portal tracts).
4) Reasonable exclusion of other insults that might cause
a similar pattern of injury (see text).