[1714] Liver Transplant Biopsies (LTx) with Sinusoidal Dilatation, Congestion and/or Hemorrhage (SDC/H): A Retrospective Review and Prospective Follow Up in 60 of 665 Liver Transplant Patients in a Tertiary Care Transplant Center

Vinushree Swamy, Veena Shah. Henry Ford Hospital, Detroit, MI

Background: Sinusoidal dilatation, Congestion and/or Hemorrhage (SDH/C) indicate venous outflow obstruction and ischemia in the liver. However, this has not been studied in the context of transplanted livers. The latter with the multiple vascular anastomoses, post operative complications and patient comorbidities present unusual and challenging situations which are different from the native livers. To our knowledge this is the first series to analyze the etiologies and follow up the clinical course of the transplanted liver with SDC/H.
Design: All the transplant liver biopsies from a transplant center with the diagnosis of SDC/ H were retrieved from Jan 2006 to April 2012. Slides were reviewed by three GI pathologists to assess the severity of the sinusoidal dilatation, congestion, centrilobular hemorrhage. Electronic medical records were reviewed to compile the possible etiology like congestive heart failure (CHF),Doppler confirmed vascular pathology like hepatic artery stenosis/thrombosis, Inferior venacava obstruction and perihilar hematoma.Prospective follow up included graft survival/ loss, complications and related deaths. Duration of follow up ranged from 6 months to 6 years.
Results: SDC/H was diagnosed in 60/665 (9%) transplanted Livers. Dilatation was mild in 61.66%, moderate in 15.51% and severe in 23.33%. Congestion and hemorrhage was mild in 60%, moderate in 20% and severe in 20%. Nine out of 60 patients (15%) lost the graft.

EtiologyGraft lost (9 cases)Graft survived (51 cases)
Anastomotic complication/Hepatic artery stenosis/Thrombosis75
Inferior venacava obstruction18
Perihilar hematoma13
Congestive heart failure015


No relevant etiology was found in 12/60 cases. Three patients expired during the followup period. Autopsy was performed in one of three expired. Autopsy confirmed dilated cardiomegaly and sequele of prolonged CHF. Budd Chiari malformation and Angiosarcoma was diagnosed in one case.
Conclusions: SDC/H is diagnosed frequently in LTx. In this special setting the etiologic factors are more diverse as compared with non transplant livers. Graft losses occur with devastating outcomes, more frequently in arterial anastomotic complications related SDC/H. It is not only CHF and/or venous outflow obstruction responsible for SDC/H but other etiologies like vascular anastomotic complications and perihilar hematoma can also manifest itself as SDC/H on biopsy, as seen by our results.
Category: Liver

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 263, Monday Morning

 

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