Recurring fibro-obliterative venopathy in liver allografts

Recurrent diseases in liver allografts are not uncommon. These occur most f requently in those transplanted for viral hepatitis B and C. We report an u nusual case of recurrent process in two consecutive liver allografts receiv ed by a 37-year-old woman, who previously had an unremarkable past medical history but developed a rapidly progressive cholestatic liver failure. Hist opathologic examination of the native liver showed fibroocclusive lesions o f both terminal hepatic venules and portal vein branches. The exuberant fib roobliterative process created dense fibrosis with whorled appearance, and broad fibrous septa connecting adjacent central areas, and sometimes bridgi ng portal to central areas. Dense portal fibrosis resulted in compression a trophy and loss of bile ducts. The first allograft, which failed within 3 m onths, showed histopathologic findings similar to that of the native liver. A liver biopsy that was performed 20 months after the second liver transpl ant again showed similar histopathology. The histopathologic features and c linical presentation of this patient suggest an unusual form of recurring p rogressive fibroobliterative venopathy causing liver failure.