Liver transplant biopsy interpretation: Diagnostic considerations and conundrums

Liver transplantation is now a well-established therapeutic strategy for irreversible acute and chronic liver diseases. There is a broad spectrum of complications encountered in early and late period after transplantation and these contribute to significant morbidity and mortality. Distinguishing am...

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Main Author: Archana Rastogi
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2022-01-01
Series:Indian Journal of Pathology and Microbiology
Subjects:
Online Access:http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2022;volume=65;issue=2;spage=245;epage=257;aulast=Rastogi
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author_facet Archana Rastogi
author_sort Archana Rastogi
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description Liver transplantation is now a well-established therapeutic strategy for irreversible acute and chronic liver diseases. There is a broad spectrum of complications encountered in early and late period after transplantation and these contribute to significant morbidity and mortality. Distinguishing among these complications often requires interpretation of allograft biopsies. Histology is the gold standard for the diagnosis of rejection. However, interpretation of these biopsies is quite challenging due to the atypical and complex histomorphology. Multiple simultaneous insults, effects of immunosuppression (IMS), de novo complications, and presentations distinct from non-transplant setting are a few cardinal concerns. Awareness of the time period of occurrence of various complications, the most characteristic histological features or patterns, and distinguishing features between various complications are crucial. The management can be completely divergent; hence, recognition of dominant problem and interpretation in appropriate clinical context is much needed. This review focuses on histopathology of major complications accountable for early and late graft dysfunction. Tabulation of clinico-pathological features to distinguish various complications helps to solve the conundrums and arrive at the correct diagnosis.
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spelling doaj.art-8622310adb36458faec54d0b04bce48d2022-12-22T00:41:34ZengWolters Kluwer Medknow PublicationsIndian Journal of Pathology and Microbiology0377-49292022-01-0165224525710.4103/ijpm.ijpm_1090_21Liver transplant biopsy interpretation: Diagnostic considerations and conundrumsArchana RastogiLiver transplantation is now a well-established therapeutic strategy for irreversible acute and chronic liver diseases. There is a broad spectrum of complications encountered in early and late period after transplantation and these contribute to significant morbidity and mortality. Distinguishing among these complications often requires interpretation of allograft biopsies. Histology is the gold standard for the diagnosis of rejection. However, interpretation of these biopsies is quite challenging due to the atypical and complex histomorphology. Multiple simultaneous insults, effects of immunosuppression (IMS), de novo complications, and presentations distinct from non-transplant setting are a few cardinal concerns. Awareness of the time period of occurrence of various complications, the most characteristic histological features or patterns, and distinguishing features between various complications are crucial. The management can be completely divergent; hence, recognition of dominant problem and interpretation in appropriate clinical context is much needed. This review focuses on histopathology of major complications accountable for early and late graft dysfunction. Tabulation of clinico-pathological features to distinguish various complications helps to solve the conundrums and arrive at the correct diagnosis.http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2022;volume=65;issue=2;spage=245;epage=257;aulast=Rastogiallograft biopsyearly graft dysfunctionlate graft dysfunctionliver transplantrecurrencerejection
spellingShingle Archana Rastogi
Liver transplant biopsy interpretation: Diagnostic considerations and conundrums
Indian Journal of Pathology and Microbiology
allograft biopsy
early graft dysfunction
late graft dysfunction
liver transplant
recurrence
rejection
title Liver transplant biopsy interpretation: Diagnostic considerations and conundrums
title_full Liver transplant biopsy interpretation: Diagnostic considerations and conundrums
title_fullStr Liver transplant biopsy interpretation: Diagnostic considerations and conundrums
title_full_unstemmed Liver transplant biopsy interpretation: Diagnostic considerations and conundrums
title_short Liver transplant biopsy interpretation: Diagnostic considerations and conundrums
title_sort liver transplant biopsy interpretation diagnostic considerations and conundrums
topic allograft biopsy
early graft dysfunction
late graft dysfunction
liver transplant
recurrence
rejection
url http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2022;volume=65;issue=2;spage=245;epage=257;aulast=Rastogi
work_keys_str_mv AT archanarastogi livertransplantbiopsyinterpretationdiagnosticconsiderationsandconundrums