{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:29:24Z","timestamp":1789190964823,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,1,16]],"date-time":"2020-01-16T00:00:00Z","timestamp":1579132800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["17H04095"],"award-info":[{"award-number":["17H04095"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["26460600"],"award-info":[{"award-number":["26460600"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Diagnosis of primary biliary cholangitis (PBC), which recurs in approximately 30% of liver transplant recipients, is histology\u2010based, but no staging system has been established for recurrent PBC (rPBC). We used the Nakanuma staging system and cytokeratin\u00a07 (CK7) staining to examine post\u2010transplant liver biopsy specimens retrospectively and to evaluate histological features of rPBC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From 107 patients who underwent living donor liver transplantation for PBC, 60 recipients with 214 liver biopsies after 1\u2010year post transplant were enrolled. Fibrosis, bile duct loss (BL), cholangitis activity, hepatitis activity, and CK7\u2010positive hepatocytes were scored. Nakanuma staging was based on fibrosis and BL scores. We examined the correlation of scores and clinicolaboratory data among rPBC patients. We also evaluated whether chronological change of stage was correlated with liver\u2010related failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 214 biopsies, 52 were protocol biopsy; 162 were episodic. Higher BL, cholangitis activity, and hepatitis activity scores were associated with rPBC diagnosis. At median follow up of 10.0\u00a0years (range 1.4\u201318.7\u00a0years), 29 (48%) patients were diagnosed with rPBC at 4.6\u00a0years (range 1.3\u201314.5\u00a0years). Liver\u2010related failure occurred in five rPBC cases; three from rPBC, and two from chronic rejection. At rPBC diagnosis, higher BL and CK7 scores were more frequent in patients who developed liver\u2010related failure than in other patients (<jats:italic>P<\/jats:italic>\u2009=\u20090.04, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01, respectively). In failure patients, the Nakanuma stage increased over time, and reached up to stage\u00a04, whereas the Scheuer stage did not reach above stage\u00a03.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Nakanuma staging is associated with rPBC and disease progression. Scores for BL and CK7 might be early markers for progressive rPBC.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.13476","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T16:46:57Z","timestamp":1576687617000},"page":"478-487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Use of Nakanuma staging and cytokeratin\u00a07 staining for diagnosing recurrent primary biliary cholangitis after living\u2010donor liver transplantation"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9274-0000","authenticated-orcid":false,"given":"Noriyo","family":"Yamashiki","sequence":"first","affiliation":[{"name":"Organ Transplantation Unit Kyoto University Hospital  Kyoto Japan"},{"name":"Department of Gastroenterology and Hepatology Kansai Medical University  Hirakata City 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