Liver Transplant - Case 18
Contributed by Anthony J.
The patient is a 71-year-old woman who underwent liver
transplantation in 1989 and recently has elevated liver function
tests. The original concern of areas of confluent necrosis being
viral in etiology was raised because of occasional subsmudged
cells. The current interpretation in light of the patient's
profound cholestasis is that these represent bile infarcts and
possibly biliary obstruction. This impression was supported by
subsequent discussion with the clinicians who indicate that early
on in the patient's course, she appeared with hepatic artery
thrombosis and developed biliary strictures of apparent ischemic
origin. The presence of bile duct injury at the same time raises
the possibility of a component of chronic rejection. Review of
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