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Liver and intrahepatic bile ducts-nontumor

Transplantation

Liver transplantation - general


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 17 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● 3 year overall survival rate is 70%
● Biopsy necessary to document allograft rejection
● Common reasons for transplant: congenital biliary atresia (children), Hepatitis C (adults), cholangiocarcinoma (Clin Liver Dis 2011;15:699)
● Explanted livers from patients with familial amyloidotic polyneuropathy, but not apolipoprotein A-I amyloidosis with Arg26 mutation, can be used for other patients (domino style transplantation, Hum Pathol 2000;31:40, Mod Pathol 2001;14:577)
● Primary EBV infection reported in 60% of EBV seronegative patients; reactivation in 20% of seropositive patients
● Monitor posttransplant lymphoproliferative disease (polyclonal B cell proliferation, B cell lymphoma) with allograft liver biopsy to detect acute rejection when the immunosuppression is reduced
● May also have surgical complications such as Budd-Chiari syndrome, portal vein thrombosis, arterial thrombosis, biliary tract complications
● Hepatitis B and C usually recur post-transplant (Hum Pathol 2000;31:101); are major causes of cirrhosis (Hum Pathol 1999;30:39)
Steatosis: microsteatosis in donor liver biopsies has no effect on graft function; ischemic injury with development of steatosis in early posttransplantation period is uncommon, may be associated with Hepatitis C and poor clinical outcome (Hum Pathol 2000;31:1209)
Preservation injury: injury to liver during period from final phase of donorís life to implantation into recipient (Transplantation 2001;71:1566)

Prognostic factors
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● Combinations of centrilobular hepatocyte ballooning, dropout and cholestasis are associated with ischemic / perfusion damage early post-transplant (due to harvesting, transporting, reperfusion issues, usually reversible)
● Presence of all three is associated with poor outcome
● Central venulitis is not a prognostic factor (Hum Pathol 2002;33:270)

Case reports
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● 57 year old man who accumulated Thorotrast in liver allograft 10 years after transplant (Mod Pathol 2004;17:117)
● Two cases of extranodal MALT lymphoma post-transplant (Am J Surg Pathol 2000;24:100)

Micro images
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Thorotrast in liver explant


Thorotrast in liver biopsy 10 years post-transplant

Electron macroscopy images
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Thorotrast electron-dense deposits

Additional references
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Hum Pathol 1999;30:1479 (outcomes in Japan in children)

End of Liver and intrahepatic bile ducts-nontumor > Transplantation > Liver transplantation - general


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