Biliary dilatation in asymptomatic AIDS patients

Cholangiopathy in HIV-infected patients

HIV cholangiopathy is a disease of advanced-stage AIDS that presents with biliary symptoms and anicteric cholestasis. An abnormal ultrasound examination in a patient with low CD4 count is evaluated by endoscopic retrograde cholangiopancreatography, which demonstrates the characteristic cholangiographic abnormalities. Besides being the gold standard for diagnosis, it offers therapeutic intervention and possible pain relief in the presence of papillary stenosis. An infectious pathogen is identifiable in a majority of patients, suggesting infection-related damage to the biliary tree. Anti-infective therapy, however, usually is ineffective, and prognosis is related to the underlying stage of AIDS.

The immunological role of biliary epithelial cells in human liver transplant rejection

From histopathological analyses after liver transplantation it is evident that the biliary epithilium is an important target for leucocytes of the graft recipient. Besides clinical and histopathological investigations undertaken by several authors it was also endeavoured to determine the immunological impact of the biliary epithelial cells (BEC) in vitro. As for the intrahepatic BEC, in vitro studies proved to be restricted owing to difficult isolation procedures and the limited number of cells yielded from transplanted organs. Therefore, studies on cultured extrahepatic BEC served as a model for the immunological features of the biliary epithelium in transplantation. Herein, in vivo and in vitro studies dealing with BEC and immunologically mediated hepatic disorders are reviewed in order to understand better the pathogenesis after liver transplantation. Furthermore, possible underlying mechanisms of BEC-directed immunity with regard to BEC-leucocyte interactions are discussed.