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Liver allograft biopsies with histological cholestasis: a clinicopathological study of 254 cases from a single centre
  1. Regina Cheuk-lam Lo1,2,
  2. Kristy Kwan-shuen Chan1,
  3. Kenneth Siu-ho Chok2,3,
  4. Irene Oi-lin Ng1,2
  1. 1Department of Pathology, The University of Hong Kong, Hong Kong, China
  2. 2State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
  3. 3Department of Surgery, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Dr Regina Cheuk-lam Lo, Room 216A, University Pathology Building, Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China; reginalo{at} and Irene Oi-lin Ng, Room 127B, University Pathology Building, Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; iolng{at}


Aims Liver allograft biopsy is important in the management of liver transplant (LT) recipients. Cholestasis is an indicator of liver dysfunction, and histological evidence of cholestasis can be observed in a wide range of pathological entities in the post-LT setting. In this study, we describe the clinicopathological features and significance of liver allograft biopsies with histological cholestasis over 11 years in our centre.

Methods Liver allograft biopsies performed in Queen Mary Hospital, Hong Kong from 2004 to 2014 showing histological cholestasis were retrieved from the pathology archive. Clinical and pathological data were retrospectively reviewed and analyzed.

Results Among the 254 biopsies from 167 patients, large duct obstruction (LDO) and acute cellular rejection (ACR) were the two main aetiologies associated with cholestasis. There was a decrease in sepsis as a cause over the study duration. In cases showing cholestasis at 6 months or more after LT, LDO was more common than ACR. Over half (61%) of the 254 biopsies showed mild cholestasis. Severe panacinar cholestasis was more often observed in LDO. Mild cholestasis was most commonly observed regardless of the severity of ACR. Severe cholestasis was associated with poorer 1-year and 3-year graft survival and patient survival, as well as higher 3-month and 6-month post-biopsy mortality.

Conclusion Histological cholestasis and its severity in liver allograft biopsies has clinical and prognostic significance. Our study summarizes our previous experience and provides further insights into the management of post-LT patients.

  • allograft
  • liver transplant
  • cholestasis

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  • Handling editor Iskander Chaudhry.

  • Contributors RCL conceived the study, designed the research plan, collected the data, analysed the data and wrote the manuscript. KKC performed data and statistical analysis, KSC provided the clinical data. ION provided advice on the project. All authors reviewed the manuscript.

  • Competing interests None declared.

  • Ethics approval IRB HKU/HA HKW, Hong Kong.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data are available.

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