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Sinusoidal dilatation and congestion in post-transplant liver biopsies from patients presenting with transaminitis
  1. Neha Bakshi1,
  2. Archana Rastogi1,
  3. Viniyendra Pamecha2,
  4. Chhagan Bihari1
  1. 1 Pathology, Institute of Liver and Biliary Sciences, Delhi, India
  2. 2 Hepatopancreaticobiliary Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, Delhi, India
  1. Correspondence to Dr Chhagan Bihari, Pathology, Institute of Liver and Biliary Sciences, New Delhi 110070, India; drcbsharma{at}


Aims Sinusoidal dilatation and congestion (SDC) in liver biopsy may be obstructive (due to venous outflow impairment) or non-obstructive in nature. The significance of this finding in the post-liver transplant setting remains unexplored.

Methods We herein retrospectively analysed all post-transplant liver biopsies showing SDC and examined histopathological features in detail. Association with transaminitis and concurrent graft rejection was assessed.

Results A total of 30 post-transplant liver biopsies from 27 patients showed SDC with atrophy of hepatocyte cords (SDC; incidence 7.4%). All patients had transaminitis. Most patients (n=22; 81.5%) were asymptomatic with deranged liver function tests (LFTs) detected during routine follow-up, raising clinical suspicion of graft rejection. SDC was non-obstructive in 19 (70.4%) and obstructive (due to sinusoidal obstruction syndrome (SOS)) in 8 (29.6%) cases. The incidence of SOS was 2%. SDC was mild, moderate and severe in 18 (66.7%), 7 (25.9%) and 2 (7.4%) cases, respectively. Perivenular and centrilobular sinusoidal fibrosis was seen in the obstructive SDC group (n=3, 11.1%). Concurrent graft rejection was present in 7 (25.9%) cases, of which acute cellular rejection comprised 5 (18.5%), and late acute rejection accounted for 2 cases (7.4%). Serum tacrolimus levels ranged from normal (n=14) to below and above normal (n=5 each). Modulation of immunosuppressive therapy led to normalisation of LFTs in one patient.

Conclusion Obstructive and non-obstructive SDC in post-liver transplant patients presenting with transaminitis mimics graft rejection clinically and may represent a form of drug-induced liver injury. Liver biopsy plays a crucial role in the diagnosis.

  • transplantation
  • liver
  • graft rejection

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  • Handling editor Runjan Chetty.

  • Contributors CB designed the study and performed histopathological analysis, revision and improvement of the manuscript. NB collected the clinical details from the hospital information system and assisted in the histopathology work, drafted the manuscript and made revisions. AR reviewed histopathology slides and provided pathology-related inputs. VP provided hepatology and transplant-related clinical inputs.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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