Male 60 years

Liver transplant for HCV and HCC January 2011
Early recurrence with lobular hepatitis at two months. Biopsy (not circulated) also showed changes in keeping with mild acute rejection.
Persistently deranged LFTs. First circulated biopsy (Bham A1/2011 Slide 153372) obtained May 2011. LFTs at this time - AST 132 (normal <43), Alk Phos 510 (<330), bilirubin 50 (<22).
HCV-RNA 195,000 IU/ml. Baseline immunosuppression slightly increased following this biopsy. LFTs steadily worsened. HCV-RNA (July 2011) – 1.2 million IU/ml. LFTs on 14/09/11 - AST 304, Alk Phos 810, bilirubin 157. Second circulated biopsy (Bham A2/2011 Slide 153373) obtained 18/10/2011. Clinical impression - aggressive HCV recurrence. Biopsy prior to decision regarding anti-viral therapy.

Female 19 years

Liver transplant for fulminant nonA-nonB-non-C hepatitis 28/11/10, urgent retransplant 28/11/10 after initially working well. Explant showed massive haemorrhagic necrosis with prominent intrasinuosidal thrombus and some recent veno-occlusive type lesions in hepatic veins. Biopsies on 6/12 and 21/12 for "stuck LFTs" showed severe cholestasis with no evidence of rejection, some ductular reaction and possibility of biliary tract problem raised. First circulated bx (Bham B1/2011 Slide 153374) 15/1/11. Persistently abnormal LFTs, including recent rise in AST. Current LFTs: AST 200, Bilirubin 79, ALP 2433. - 2 further biopsies 25/1 and 21/4 as LFTs continued to be abnormal (AST 6-120ish, Alk Phos (800-1000). Second circulated biopsy (Bham B2/2100 Slide 153376) on 13/5/11 for a further recent elevation in AST to approx 300. Of note at approx 25 weeks post transplant Donor specific antibodies were assessed and she was found to have both Class I and Class II DSAs.

Sex unknown age unknown

This biopsy 6 years post OLT. Previously: Severe rejection at 3 weeks, moderate rejection at 4 weeks. Artery refashioned at 6 weeks.

Male 47 years

Primary sclerosing cholangitis.

Liver biopsy 1999 confirmed cirrhosis. Idiopathic thrombocytopenic purpura (Cambridge B/1 slide 153387). Graft biopsy at 11.5 months (Cambridge B/2 slide 153386).

Male 58 years

Liver transplant 05.06.11. Increased LFTs. ?rejection. This biopsy 13 weeks post transplant. Two previous post-transplant biopsies showed rejection.

Female 57 years

Hepatitis C cirrhosis. (The report implies this is an explant 5 years post transplantation).

Male 63 years

Liver transplant 2008 for ALD/NASH cirrhosis.
In 2009 had post transplant anastomotic biliary stricture with CBD stones - dilated and stones removed. Now liver biopsy because elevated ALT >200 (was normal 4 months ago); alk phos and bilirubin are normal.

Male 60 years

Biopsy 2 years post transplant for HCV. Protocol biopsy. Last year's biopsy = consistent with mild recurrent hep C, Ishak stage 1 grade 2.

Female 45 years

4 months post transplant for paracetamol overdose. Day 8 mod-severe acute rejection, still on-going 2 weeks post-transplant. 3 weeks post-transplant marked perivenular cholestasis ? sepsis, ?humoral rejection. This biopsy is 4 months post-transplant with persistently increased LFTs, alk phos 270, ALT 117. ? rejection.

Female 26 years

3years 8months post transplant for paracetamol overdose. Previously biopsy 1 week post-transplant - extrahepatic sepsis. 1 1/2 years post transplant, severe hepatiitis with bridging and confluent necrosis. This biopsy is 3 1/2 years post transplant with jaundice, fibrotic liver and ascities. Bilirubin 230, ALT 332, alk phos 247, GGT 193. Tacrolimus 7.3. USS patient vessels. Previous non-compliance. ? chronic rejection, ? cirrhosis.