Female 53 years

Morbid obesity, contemplating surgery. Fibroscan gave poor quality markers, so accuracy uncertain. Presumed fatty liver, to determine presence of steatohepatitis and severity of fibrosis. Additional information from CPC meeting - BMI 46, weighs 140kg, FIbroscan 10.5.

Female 35 years

Patient with immune mediated disease including Sjogrens and is AMA +ve, M2 type. Now presented with decompensated liver disease. Clinically not fully in keeping with PBC alone and also variable intake of alcohol to ease pain from arthritis. To rule out other cause for liver disease before transplanting urgently.

Female 33 years

Past medical history of psoriasis. Unresponsive to fumeric acid esters. ? for methotrexate 2 years later, second biopsy 364709 Proriasis - was previously on methotrexate and cyclosporin, now stopped because of raised ALT. Had liver biopsy 2 years ago and did not show steatohepatitis or fibrosis. Hyperthyroidism, BMI 34, raised ALT, +ve SMA and slightly raised IgG. Recent Secukinumab therapy (anti IL17A) US - fatty liver. ? autoimmune, ? drug induced. Biopsy to determine if further methotrexate therapy is reasonable? Can Secukinumab therapy continue?

Female 44 years

Rheumatoid arthritis. Deranged LFTs, ? source. From accompanying clinic letter - patient has been taking methotrexate for 10 years at 25mg per week for 6 years then 15mg per week for 4 years. Normal liver function tests, and normal BMI, presented with low platelets and stigmata of chronic liver disease. Liver screen - positive ANA, nil else.

Female 68 years

Referred to Birmingham with 2 week history of jaundice and progressive liver failure. No drug or alcohol history. LFTs at the time of admission were ALT 1430, AST 1740, Alk Phos 253, bilirubin 127. A liver biopsy obtained at the referring hospital was sent for review (Slide A1/2019 - 1000992). Shortly after admission underwent super-urgent liver transplantation. Hepatectomy specimen was shrunken (weight 820g) and nodular. Slide A2/2019 1000993 is from the right lobe of the liver explant.

Female 57 years

PBC diagnosed in 2006. AMA - negative, ANA-positive 1:1600 with multinuclear dot pattern, SMA positive 1:160, anti-centromere positive. IgG 11.9. BMI 31.5. Non-responder to treatment with UCDA. Recently participated in clinical trial using novel agent Elafibranor (agonist of the peroxisome proliferator-activated receptor-alpha and peroxisome proliferator-activated receptor-delta). Has also been treated with cephalexin for UTIs. Worsening liver tests 1 month after finishing treatment with Elafibranor - ALT 557, AST 590, gamma GT 537, Alk Phos 448, bilirubin 8. First liver biopsy obtained in July 2018 (Slide B1/2019 1000994). Differential diagnosis at this time included DILI and autoimmune dominant PBC. Treated with corticosteroids, but failed to achieve normalisation of ALT. Subsequently became jaundiced with worsening LFTs. Second liver biopsy obtained in September 2018 (Slide B2/2019 1000995). LFTs at this time were: ALT 436, Alk Phos 167, bilirubin 115.

Female 18 years

Liver transplant for PSC/autoimmune hepatitis in August 2018. Initial post-operative recovery was unremarkable. Developed sudden massive rise in transaminases 1 week post-transplant. AST rose from 40 on day 7 to 9773 on day 10. Cause uncertain. Hepatic artery patent on imaging.

Liver biopsy obtained 10 days post-transplant (Slide C1/2019 1000996). Underwent urgent retransplantation 2 days later. Hepatectomy specimen was enlarged (weight 2270g) with a red cut surface. No focal lesions were seen. Slide C2/2019 1000997 is from the right lobe of the liver explant.

Previously fit and well young adult man with 2 month history of malaise, weight loss, brief diarrhoea, occasional RUQ pain and with mild jaundice. Viral screens (hepatitis A, B, C, E, CMV, EBV) negative. Immunology and Ig pending. Has taken Gym supplements (but no anabolic steroids) for several months but stopped a month ago. ALT 866 U/l, ALP 154 U/L, GGT 396 U/L, raised ferritin, normal caeruloplasmin.

Man in 50s with a renal transplant for several years (working well, on tacrolimus MMF and prednisolone) has developed ascites and peripheral oedema. Liver screen negative. HEV antibody positive (IgG). Transjugular biopsy. History of hypertension and AF (on warfarin, nifedipine, atorvastatin, lansoprazole).

Man in 50s referred by GP due to positive HBVsAg. No family history of HBV. UK resident for 30 years. Past treated TB. Ex-smoker. 4 units alcohol/day. 55kg. ALT 40. Provisional diagnosis: chronic hepatitis B.

Female 72 years

Presented with pruritis and cholestatic LFTs; ALP 670, GGT 3775, ALT 120; ANA weakly positive, negative for AMA, SMA, LKM, DNA. USS normal.

Liver biopsy performed.

Male 70 years

For liver transplant assessment; previous ulcerative colitis, now jaundiced H&E, EPSR, orcein, CK7.

Female 74 years

Jaundiced, dilated ducts on imaging. Spybite biopsy.

Male 49 years

Originally from Eastern Africa, HIV well controlled on HAART, cholestatic LFTs. H&E, EPSR, victoria blue.

Female 44 years

African HIV well controlled on HAART, jaundiced.

Male 50 years

Tender hepatosplenomegaly with cholestatic LFTs.