Liver & intrahepatic bile ducts
Liver transplantation
Early onset graft injury
Liver transplantation overview

Topic Completed: 1 May 2012

Minor changes: 1 August 2020

Revised: 23 November 2019, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Liver transplantation[TI] general[TI]

Komal Arora, M.D.
Page views in 2019: 713
Page views in 2020 to date: 759
Cite this page: Arora K. Liver transplantation overview. website. Accessed September 19th, 2020.
Definition / general
  • 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 AI 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 posttransplant (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 donor's life to implantation into recipient (Transplantation 2001;71:1566)
Prognostic factors
  • Combinations of centrilobular hepatocyte ballooning, dropout and cholestasis are associated with ischemic / perfusion damage early posttransplant (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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