It reveals residual portal and centrizonal lymphocytic infiltrate. The centrizonal infiltrate is associated with hemorrhage and hepatocellular dropout with features suggestive of central venulitis. The portal tracts show some residual bile duct damage.
Hepatic vessels are patent on imaging studies.
This dual portal and centrizonal inflammation has been noted in this patient on several recent biopsies that we have included for review. On the previous biopsies we have interpreted the changes as representing both recurrent hepatitis C and acute rejection. In this series of biopsies there are qualitatively similar changes throughout, but quantitatively there are some variations in the sequential samples. Therefore, the sequence will be described together with particular reference to each sample and then an overall impression will be given on the patient course and in particular on the most recent biopsy. The first is a severe central venulitis characterized by lymphoplasmacytic perivenular inflammation associated with variable degrees of congestion, hepatocyte dropout, and deposition of pigmented macrophages and variable central vein fibrosis.