Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Case Report

Volume 17, Number 1, February 2024, pages 37-40

Primary Non-Function of Hepatic Allograft With Preexisting Microvesicular Steatosis/Foamy Degeneration and Mild Large-Droplet Macrovesicular Steatosis

Figure

Figure 1.
Figure 1. (a) Permanent sections of liver core biopsy taken at time of harvest showed diffuse microvesicular steatosis, mild LD-MAS (5% total), and no evidence of hepatocyte necrosis or inflammation (H&E stain). (b) Core needle biopsy taken at reperfusion (time 0 biopsy) showed diffuse microvesicular steatosis, hemorrhage, hepatic ischemic injury (loss of nuclear staining) and fat droplets in sinusoids (lipopeliosis) (H&E stain). (c, d) Permanent sections of the failing allograft at 24 h post-transplant showed diffuse microvesicular steatosis, hemorrhagic necrosis, mild LD-MAS, and no evidence of acute cellular or antibody-mediated rejection (H&E stain). (e) Sections of the failed allograft after explantation showed extensive hepatocyte necrosis, inflammation, and ductular reaction without evidence of cellular rejection (H&E stain). (f) High power view showed diffuse microvesicular steatosis, ischemic necrosis, mild LD-MAS in hepatocytes (20%) and large, irregular vacuoles in the sinusoids (10% total) (H&E stain). H&E: hematoxylin and eosin; LD-MAS: large-droplet macrovesicular steatosis.

Tables

Table 1. Liver Function Tests
 
Before transplant7 h after starting liver transplantation12 h after starting liver transplantationAt time of re-transplantation6 weeks after re-transplantation14 months after re-transplantation
ALT: alanine aminotransaminase; AST: aspartate aminotransferase; PT: prothrombin time; INR: international normalized ratio; Ref.: reference; N/A: not available.
ALT (Ref. 7 - 55 U/L)341,4371,4221,3291330
AST (Ref. 10 - 50 U/L)4411,10016,00010,2001236
Ratio of AST/ALT1.37.711.37.70.90.8
Total bilirubin (Ref: 0.1 - 1.2 mg/dL)3.03.73.84.70.20.6
PT (Ref. 9.5 - 3.6 s)17.549.618.918.112.1N/A
INR (Ref. 0.9 - 1.0)1.64.21.71.61.1N/A

 

Table 2. Pathologic Findings in Liver Specimens
 
TimeTypeSizeMISTotal LD-MASaExtracellular fat globules in sinusoidsHepatocyte necrosisLobular inflammationPortal tract changes
aTotal LD-MAS: total LD-MAS including intrahepatocellular LD-MAS and extracellular/sinusoidal LD-MAS; MIS: microvesicular steatosis; LD-MAS: large-droplet macrovesicular steatosis.
At harvestNeedle core (frozen and permanent)Four cores, 0.8 - 1.4 cm in length95%5%NoneNoneNoneNone
Immediately after reperfusionNeedle core1.7 cm in length90%10%5%5-10%Focal and neutrophilicFocal, ductular reaction
Immediately before allograft removalWedge (frozen and permanent)4.6 × 1.5 × 1.0 cm80%20%10%60%Patchy and neutrophilicDiffuse, ductular reaction
Removal of failed liver allograftLiver2,500 g, mottled capsule, pale tan-yellow cut surface80%20%10%50-60%Patchy and neutrophilicDiffuse, ductular reaction