Fibrosis/cirrhosis after orthotopic liver transplantation

The causes and pathologic changes leading to fibrosis and cirrhosis after o rthotopic liver transplantation (OLT) are not fully defined. The computeriz ed pathology files were searched for cases of fibrosis/cirrhosis after OLT. Of 493 grafts from 435 patients, 35 grafts from 32 patients of posttranspl antation liver fibrosis/cirrhosis were identified and retrieved (7%). Detai led histopathologic examinations of all post-OLT liver biopsy specimens wer e performed in conjunction with clinical, virologic, serologic, and molecul ar diagnostics information. Two cases with subcapsular septa and fibrous ti ssue close to hilum were excluded as false positives. Fibrosis/cirrhosis wa s confirmed in the remaining 33 grafts. In 20, the underlying cause was rec urrent viral hepatitis, including eight with hepatitis C, 10 with hepatitis B, and two with combined hepatitis C and B. Another two with pretransplant ation chronic hepatitis B developed cirrhosis without detectable virologic markers after OLT; these were biliary type secondary to obstruction in one, and chronic changes due to severe graft ischemia in one. Three patients ac quired hepatitis C after OLT, with molecular confirmation available in two. In five patients, the underlying causes were Budd-Chiari syndrome and auto immune hepatitis, recurrent autoimmune hepatitis, recurrent primary biliary cirrhosis, alcohol-induced liver disease, and recurrent bile duct carcinom a. Three cases had centrilobular fibrosis but without bridging septa or cir rhosis as a result of chronic rejection. It was concluded that (1) Cirrhosi s after OLT is uncommon (7%). (2) Chronic rejection does not lead to cirrho sis, but it may result in centrilobular fibrosis. (3) In most (70%) cases, cirrhosis after OLT is attributed to recurrent or acquired viral hepatitis. HUM PATHOL 30:39-47. Copyright (C) 1999 by W.B. Saunders Company.