Liver Pathology in Transplantation

  • Hironori HagaEmail author


Liver transplantation is a treatment for almost all kinds of severe liver diseases that are otherwise incurable. A part of the donor’s liver is used for live donor liver transplantation, and partial grafts often need complicated surgical procedures and tend to have a greater risk of postoperative vascular and biliary anastomotic stricture or obstruction than livers resected for non-transplant settings. Interpretation of liver allograft biopsy is a multidisciplinary procedure; the liver transplantation procedure, the timing of biopsy, the laboratory data, the types and dose of immunosuppressive drugs, and the findings of previous biopsy should all be considered before making a pathologic diagnosis. In general, preservation/reperfusion injury manifests within the first week posttransplant period. Surgical complications are commonly seen in the first several weeks, except that biliary complications may also be seen months after transplantation. Typical acute allograft rejection is characterized by endothelial and biliary inflammatory damages with portal lymphocytic inflammatory infiltrates, and usually seen between 5 and 30 days posttransplantation. Late-onset rejection may be treatment-resistant or associated with nonadherence to immunosuppressive drugs. Incidence of recurrence of original liver diseases increases with time after transplantation.


Preservation/reperfusion injury Hyperacute rejection Acute rejection Late acute rejection Chronic rejection T-cell-mediated rejection Antibody-mediated rejection Immune tolerance Protocol biopsy 



Antibody-mediated rejection


Antigen-presenting cell


Epstein-Barr virus


Graft-versus-host disease

H & E

Hematoxylin and eosin


Hepatitis B virus


Hepatitis C virus


Human leukocyte antigen


Major histocompatibility complex


Non-alcoholic steatohepatitis


Posttransplant lymphoproliferative disorder


T-cell-mediated rejection


Regulatory T cell


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.KyotoJapan

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