Spectrum of Histopathological Findings in Live Donor Liver Graft Biopsies

Objective: To study the spectrum of histopathological findings in live donor liver graft biopsies. Study Design: Case series. Place and Duration of Study:Histopathology Department, Shifa International Hospital, Islamabad, from January 2011 to March 2014. Methodology: The biopsies were received in formalin and routinely processed. The changes encountered were divided into three categories: (i) new-onset post liver transplantation (LT) complications (early and late), (ii) acute rejection and (iii) recurrence of original disease. Banff schema 1997 of rejection activity index (RAI), modified histological activity index (mHAI) and recent literature were utilized for evaluation. The results were finalized in the light of clinical details along with relevant laboratory investigations and radiological findings. Results: Seventy eight percutaneous hepatic graft biopsies of 59 patients were evaluated. Among them, findings noticed in descending order of frequencies were Acute Cellular Rejection (ACR) in 37 percentage (n=30), recurrent hepatitis C (HCV) in 22 percentage (n=18), cholestasis/ductular proliferation in 27 percentage (n=22), ischemic/reperfusion injury in 9.8 percentage (n=8) and drug-induced liver injury in 3.7 percentage (n=3). In the first six months post LT, ACR was the commonest cause of graft dysfunction, while recurrent HCV was noticed to be predominant reason after 6 months. Conclusion: In this study, ACR was the most frequent finding in graft biopsies, followed by recurrent HCV. However, in first six months, ACR is the commonest histopathological finding while recurrent HCV was more frequently documented after 6 months. (author)