Liver Transplantation

Pathologists are integral members of a patient management team devoted to all aspects of Liver transplantation, donor selection and evaluation, diagnosis of the original disease, and all aspects of posttransplant management and follow-up. Included are helping to determine the causes of allograft dysfunction, periodically assessing microscopic Liver allograft structural integrity, and conducting basic and translational research aimed at improving outcomes.It is important to approach Liver allograft tissue specimen analysis and interpretation from a 'pathophysiological' rather than a purely 'morphological' perspective. This is because many treatment regimens and operative variations can influence the microscopic appearance of common syndromes, such as rejection, and the changes have to be anticipated and reasoned through or understood, rather than learned on a completely empirical basis. Learning by experience, however, is also needed.Therefore, we start with an overview of the Liver vasculature and microvasculature, which determines the pathophysiological manifestations of several insults, such as preservation-reperfusion injury and rejection. Next is an overview of the Liver as an immunologic organ. This is important in understanding why the Liver behaves differently from an immunologic perspective than other soLid organ allografts. Included are a resistance to antibody-mediated and chronic rejection (CR) and an abiLity to protect other organs from the same donor from rejection and to wean some stable recipients from all immunosuppression.The topics of donor evaluation, preservation-reperfusion injury, acute or chronic T-cell-mediated rejection, acute and chronic antibody-mediated rejection, CR, and molecular testing are covered in subsections devoted to cLinical presentation, pathophysiology, and histopathology.