Contributed by Parmjeet S. Randhawa, M.D.
PATIENT HISTORY: The patient is a 40 year old white male with a clinical history of status post orthotopic liver transplant.

Final Diagnosis (Case 1)

ALLOGRAFT LIVER, NEEDLE BIOPSY -
  1. CHANGES CONSISTENT WITH MILD TO MODERATE ISCHEMIC INJURY; NO EVIDENCE FOR ACUTE REJECTION.

Previous Biopsies on this Patient:
NONE

TPIS Related Resources:
Liver Allograft Biopsy Rejection Criteria
Liver Transplant Topics

Gross Description - Case 1

The specimen is received in formalin labeled "liver". Received are three cores of mottled, yellow to dark green, soft tissue. The fragments received range from 0.5 to 1.7 cm. in length each 0.1 cm. in diameter. The cores are placed in a biopsy bag and entirely submitted for stat processing labeled ALB.

Microscopic Description - Case 1

BANFF SCORING OF LIVER ALLOGRAFT BIOPSIES

1. Histological Evaluation
1.1 More than 4 portal triads (X)YES ( )NO
1.2 Specimen o/w adequate (X)YES ( )NO
2. Portal Tract (check one uner each category)
2.1 Overall Inflammatory Intensity ( )None (X)Mild ( )Moderate ( )Severe
2.2 Bile duct inflammation / damage ( )YES (X)NO
2.3 Granuloma(s) ( )YES (X)NO
2.4 Bile duct loss ( )YES (X)NO
2.4.1 If BD loss, total number of triads ( )
2.4.2 If BD loss, number of triads w/o ducts ( )
2.5 Bile duct / cholangiolar proliferation (in any portal tract) (X)YES ( )NO
3. Inflammatory or Necrotizing Arteritis ( )YES (X)NO
4. Obliterative Arteriopathy ( )YES (X)NO
5. Subendothelial Inflammation
5.1 Severity (X)None ( )Mild ( )Moderate ( )Severe
5.2 Location (X)N/A ( )Portal ( )Central ( )Both
6. Fibrosis (check one under each category)
6.1 Portal ( )None (X)Mild ( )Moderate ( )Severe (bridging)
6.2 Central (X)None ( )Mild ( )Moderate ( )Severe (bridging)
6.3 Arch. dist. (X)None ( )Mild ( )Moderate ( )Severe
7. Lobular Disarray / Ballooning (X)None ( )Mild ( )Moderate ( )Severe
8. Necrosis (check one under each category)
8.1 Piecemeal or bridging (X)None ( )Mild ( )Moderate ( )Severe
8.2 Infarct (ischemia) ( )YES (X)No
8.3 Other necrosis (X)YES ( )No
8.4 Central lobular ( )YES (X)No
9. Cholestasis ( )YES (X)NO
10. Fat ( )None (X)Mild ( )Moderate ( )Severe
10.1 Type ( )Micro ( )Macro (X)Mixed ( )N/A
11. Lobular Inflammation (check one under each category)
11.1 Severity ( )None (X)Mild ( )Moderate ( )Severe
11.2 Location ( )N/A ( )Perivenular ( )Panlobular (X)Random / Focal
11.3 Granulomatous ( )YES (X)NO
12. Rejection Activity Index (RAI) Range Score
12.1 Portal inflammation (0-3) (0)
12.2 Bile duct inflammation / damage (0-3) (0)
12.3 Venous endothelial inflammation (0-3) (0)
12.4 Total Score (RAI = 0/9)

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