Pathology of allograft liver dysfunction

In spite of significant improvements, availability, and deeper knowledge of many tools of investigation in liver transplanted patients (US, angiography, cholangiography, CT, and MRI), liver biopsy maintains a central role in the diagnosis and management of early and late postsurgery complications. Information arising from liver biopsy interpretation may be crucial for clinical decisions and therapy arrangements, but, to reach this goal, tissue samples must be representative, processed properly, and carefully evaluated by committed pathologists in order to discover significant histological pictures. Continuous and detailed communications between hepatologists and pathologists are necessary to obtain correct diagnostic details from this unique powerful procedure. Biochemical liver tests are associated with poor sensitivity and specificity in the diagnosis of graft dysfunction and usually provide only limited information about the target and the severity of graft damage. Moreover protocol scheduled liver biopsies are able to detect the early and asymptomatic stages of many diseases, occurring late after transplant and in some cases allow an early treatment that may avoid or delay graft injury and graft loss. Detailed and updated knowledge of the histological alterations observed in liver samples may improve the understanding of the post-transplant diseases that could improve post-transplant care and the final outcome.