Sex unknown age unknown

OLT for PSC February. Severe acute rejection at one week (Slide 269921) with no real response to treatment. Biopsy 21 days post transplant (Slide 269940) after a second treatment with pulse of prednisolone, showed ongoing acute cellular rejection at least moderate in severity together with features suspicious for antibody mediated rejection, including arteritis. Transaminases remain raised, however bilirubin has returned to normal. Current AST 74, ALT 114, alkaline phosphatase 500 and bilirubin 15. Given IV hydrocortisone 3 days before the circulated biopsy (Slides 269926 and 269929) which was obtained 68 days post transplant. Medium levels HLA class1 DSA identified in March. DSA levels at time of this biopsy essentially negative.

Sex unknown age unknown

OLT for HCV cirrhosis (genotype 3) in October. LFTs persistently abnormal - ? related to recurrent infection. Problems with intermittent nausea and neutropenia, possibly related to Azathioprine toxicity. Also has raised MCV. Azathioprine dose initially reduced and now stopped. LFTs remain abnormal - ? aggressive HCV recurrence/FCH. Current LFTs: ALT 77, Alk Phos 445, bilirubin 17.
Latest HCV-RNA 1.2 million IU/ml. This biopsy obtained in the July of following year, 9 months post transplant.

Male 61 years

Liver transplant for HCV cirrhosis in January.
Now raised ALT and bilirubin, ? acute rejection.

Male 56 years

Liver transplant for ALD/HCV/HCC in November. Increasing jaundice and abnormal LFTs. TJB 7th Feb following year - stage 1 HCV plus biliary changes.
MRCP - intrahepatic duct dilatation. ERCP and CBD stent 13th Feb, in good position. Increasing jaundice now, ? rejection, ? immune dysfunction.

Male 52 years

Liver transplant for HCV and HCC in February. Readmitted with jaundice 16 weeks post transplant, ALT >1000 ? cause. (Slides 269970 and 269972). Received pulsed steroids, LFTs improved for some days. Now again worsening, so repeat biopsy (Slides 269973, 269975 and 269976)

Male 59 years

OLT for ALD (JF).

4 wks - severe acute cellular rejection - Treated.

5wks - bilirubin rising - biopsy (Slides 271945 and 271937).

Persistent jaundice, severe ACR on biopsy at 6wks.

11wks - biopsy (Slides 271957 and 271966).

Male 50 years

OLT for HCV & HCC(KL).

7 days severe acute cellular rejection - treated 3 dose methyl pred.

4 days - Now LFTs off again - biopsy (Slides 271939 and 272138).

16 mo - biopsy at time of hernia repair (Slides 272122, 272111 and 272132).