Problems in the interpretation of liver biopsies after liver transplantation

As more liver transplants are performed and we realize that biopsy is the best means to diagnose rejection, the surgical pathologist has gained prominence as part of the transplant team. The surgical pathologist now plays a pivotal role in the day-to-day management of liver transplant patients. Diagnosis of rejection is a major task; however, other processes, particularly infectious ones, are also important causes of liver dysfunction that must be distinguished from rejection. Rapid and accurate diagnosis of acute rejection is possible if attention is paid to diagnostic criteria. The biopsy is also valuable to assess efficacy of therapy and provide prognostic information. The histological diagnosis of chronic rejection remains difficult, if not impossible. In all cases, and especially in the assessment of chronic rejection, close cooperation with the clinical staff is essential for proper patient management.