{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T20:49:15Z","timestamp":1761598155627,"version":"3.40.5"},"reference-count":16,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005595","name":"University of California","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this study was to perform a comprehensive retrospective analysis of liver transplant biopsies with parenchymal rejection (<jats:roman>PR<\/jats:roman>) at our institution, including histological features, laboratory values and follow\u2010up biopsies, and to compare <jats:roman>PR<\/jats:roman> with portal\u2010based acute cellular rejection (<jats:roman>ACR<\/jats:roman>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Biopsies from 173 patients were evaluated (retrospective database search 1990\u20132017), including 49 isolated <jats:roman>PR<\/jats:roman>, 35 <jats:roman>PR<\/jats:roman> with portal <jats:roman>ACR<\/jats:roman> (<jats:roman>PR<\/jats:roman>\/<jats:roman>ACR<\/jats:roman>), 34 mild <jats:roman>ACR<\/jats:roman> and 52 moderate <jats:roman>ACR<\/jats:roman> cases. The rise and fall of serum liver enzymes was calculated as a measure of acute liver injury and response to immunotherapy, respectively. Isolated <jats:roman>PR<\/jats:roman> was associated with delayed\u2010onset acute rejection (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), as well as younger age (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.004), and showed a similar rise in liver enzymes to mild <jats:roman>ACR<\/jats:roman>. <jats:roman>PR<\/jats:roman>\/<jats:roman>ACR<\/jats:roman> and moderate <jats:roman>ACR<\/jats:roman> showed the highest elevations in transaminases (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05). Isolated <jats:roman>PR<\/jats:roman> on an initial biopsy was associated with recurrent episodes of <jats:roman>PR<\/jats:roman> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01), chronic ductopaenic rejection (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.002) and chronic vascular rejection (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.017). Immunohistochemistry for C4d was performed, and strong C4d staining of venules was only detected in one severe isolated <jats:roman>PR<\/jats:roman> case (one of three, 33%) and one moderate <jats:roman>ACR<\/jats:roman> case (one of 20, 5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Isolated <jats:roman>PR<\/jats:roman> represents a form of late acute rejection with distinct clinical and histological features. There is value in reporting <jats:roman>PR<\/jats:roman> in liver transplant biopsies to identify patients at higher risk of developing recurrent <jats:roman>PR<\/jats:roman> and chronic rejection. Standardisation of terminology and histological criteria of <jats:roman>PR<\/jats:roman> can help in uniform reporting and ensure appropriate management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.14058","type":"journal-article","created":{"date-parts":[[2020,1,2]],"date-time":"2020-01-02T02:50:36Z","timestamp":1577933436000},"page":"822-831","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinicopathological features and outcomes of parenchymal rejection in liver transplant biopsies"],"prefix":"10.1111","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9966-4197","authenticated-orcid":false,"given":"Daffolyn Rachael","family":"Fels Elliott","sequence":"first","affiliation":[{"name":"Department of Pathology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Tavakol","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8347-9592","authenticated-orcid":false,"given":"Calixto\u2010Hope","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Sheahon","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"Kakar","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilal","family":"Hameed","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplantation Department of Medicine UCSF San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda D","family":"Ferrell","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,4,16]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"422","volume-title":"Experience in hepatic transplantation","author":"Porter KA","year":"1969"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(96)90013-1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199707270-00013"},{"key":"e_1_2_8_5_1","first-page":"306","article-title":"Interpretation of biopsy findings in the transplant liver","volume":"15","author":"Jones KD","year":"1998","journal-title":"Semin. Diagn. 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