Morphology of surgical complications in liver biopsies early after transplantation

Overview

Early after liver transplantation, surgical/anastomotic complications of various types are more common than in other solid organ transplants. It is not only because the complications can be related to the transplant procedure, but also due to the suboptimal quality of the graft, and/or recipient health issues. The most critical early post-transplant complication is thrombosis of the hepatic artery. Findings in peripheral core needle biopsies of allograft with a thrombosed artery can be quite variable from unremarkable features, to coagulative necrosis, marked centrilobular hepatocyte swelling and biliary features with marginal ductular proliferation and/or cholangiolitis. Therefore the differential diagnosis is broad and includes almost every syndrome associated with graft dysfunction. Biliary tract is frequently the site of minor and major complications and the majority of them are ultimately attributable to ischemic injury. Complications occurring at or near the biliary anastomosis are generally more amenable to treatment than those occurring in the liver parenchyma.

Keywords:
liver transplantation –⁠ anastomotic complications –⁠ hepatic artery thrombosis –⁠ bile duct complications