Monthly Archives: June 2011

Definition: acute cellular rejection

Acute cellular rejection (ACR) can occur anytime in the lifespan of a donor allograft, though is most common in the first year post-transplant when the level of immunosuppression is low.  It is diagnosed on biopsy with the triad of cholangiolitis, endothelialitis and … Continue reading

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Pathology: levamisole vasculitis

A young cocaine + male with HCV was admitted with an apparent cutaneous vasculitis and acute renal failure. Suspicion was high for cryoglobulinemia, but the cryocrit was normal.  Skin biopsy was performed, showing a leukocytoclastic vasculitis, with positive stains for … Continue reading

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Clinical Pearl

If a liver transplant patient presents to the clinic with leukopenia and diarrhea…think about cytomegalovirus (CMV).  This likelihood is greatest if the liver donor was CMV+ and the recipient was CMV- , though any combination can lead to this infection … Continue reading

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Hepatorenal syndrome

Question: You are confronted with a very sick 41 year old Puerto Rican male with HCV and EtOH cirrhosis, MELD score of 36, hyponatremia, large ascites and jaundice.  His creatinine is rising and is now 2.3.  Which of the following … Continue reading

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The Sunday Chronicles

“Excuse me, bartender?  I thought I said no salt. Doctor’s orders.”

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Haiku: Cryoglobulinemia

Cryoglobulins Kidney and skin deposits Will Rituxan work?

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Pathology: dilated sinusoids

The hepatic sinusoid is the smallest caliber blood vessel in the liver, and much of end stage liver disease is based on sinusoidal pressures.  Portal hypertension can be divided into pre-sinusoidal (portal vein thrombosis), sinusoidal (hepatic fibrosis) and post-sinusoidal conditions … Continue reading

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