American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which syndrome is associated with chronic liver transplant rejection?

1. Bronchiolitis obliterans

2. Vanishing bile duct syndrome

3. Interstitial fibrosis

4. Acute cellular rejection

The correct answer is: Vanishing bile duct syndrome

Vanishing bile duct syndrome is characterized by the progressive loss of bile ducts within the liver, which can occur in the context of chronic liver transplant rejection. This syndrome can lead to cholestasis, bile duct loss, and progressive liver dysfunction, making it a significant complication in the post-transplant setting. Chronic rejection manifests histologically as a form of ductopenia, where the bile ducts are destroyed leading to bile acid build-up and potential liver failure if left untreated. This condition is particularly relevant in liver transplantation because the integrity of the bile ducts is crucial for proper liver function and bile excretion. The other conditions listed, while important in transplant discussions, represent different aspects of transplant rejection or complications that may not be specifically tied to chronic rejection of the liver. For instance, bronchiolitis obliterans is primarily related to lung transplant complications, interstitial fibrosis does not specifically correlate with chronic liver rejection but rather is a concern after lung transplantation or as a manifestation of chronic rejection in different organ systems, and acute cellular rejection is a separate, earlier phase of rejection that can occur soon after transplantation but does not denote chronic rejection. That’s why vanishing bile duct syndrome stands out as the condition that specifically indicates a chronic rejection process in liver