Zhonghua Bing Li Xue Za Zhi. 2000 Dec; 29(6): 428-31.

[Pathological features of liver biopsy from 66 cases of long term blood donors with chronic hepatitis C]

Ren J, Wang L, Wang T, Lu J, Lei C, Liu X.

Department of Liver, Shuguang Hospital, Shanghai University of Traditional Medicine, Shanghai 200021, China.

OBJECTIVE: To study the pathological features of liver biopsy from long-term blood donors with chronic hepatitis C. METHODS: From 250 long-term blood donors with positive serum anti-HCV antibody for more than five years, 66 donors with abnormal ALT level were selected and enrolled in this study. Liver biopsy was performed on these cases and the specimens stained with HE, and reticulin. Modified Schemer's classification for grading and staging was used during pathological observation. Twenty biopsies with serum HCV-RNA levels higher than 5.0 Meq/ml (bDNA) were studied immunohistochemically (SABC) for NS5. RESULTS: All cases displayed mild pathological changes. Grade 1 (G(1)) inflammation was 4.8% (3/63), G(2) 63.5% (40/63), G(3) 28.6%(18/63), G(4) two case. Stage 1 (S(1)) fibrosis was 60.3% (38/63), S(2) 34.9% (22/63), S(3) 3.2% (2/63), S(4) only one case. The main lesion was periportal inflammation, such as bile duct damage (100.0%), dense lymphoid aggregates (82.5%) and piecemeal necrosis (89.5%). Intralobular injury of hepatocytes was rather mild. Bridging necrosis and steatosis were not common and observed in only 12.3% (8/66) and 9.2% (6/66) respectively. As for fibrosis, proliferation and deposition of collagen were mainly distributed in the portal and perisinusoidal areas. Among 20 specimens with serum HCV-RNA levels higher than 5.0 Meq/ml (bDNA), all bile duct epithelial cells were positive for HCV-NS5 antigen, while hepatocytes in 4 cases were negative. CONCLUSION: (1) The pathological changes in this series show overall similarity with that of patients with posttransfusion hepatitis C. The main damages are portal and periportal inflamation, such as lymphoid aggregates, bile duct damage, piecemeal necrosis, and extensive periportal and perosinusoidal fibrosis. Intralobular damage was mild with occasional steatosis, which may be related to malnutrition, low level of serum iron due to long term donation. (2) Epithilial cells of the bile duct may be of another site for virus replication, thus it is related with bile duct damage and periportal inflammation.