PMC2754079_01
PMC2754079_02
Native liver: 3000 g liver (expected weight 1500-1800 g) with dull yellow-green geographic necrosis and subcapsular blood.
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fig1
Gross inspection of the native liver revealed obvious hepatic rupture, with the organ surrounded by hematoma (Figure 1).
Native liver (40x, H&E section): at low power, one may appreciate the interface between viable and necrotic hepatic tissue.
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fig2
Histology demonstrated massive hepatic necrosis, marked steatosis, widespread bile ductular proliferation, profound cholestasis, and necrotic vessels with intravascular thrombi (Figures 2 and 3).
Native liver (100x, H&E section): higher power view of the interface in the native liver between viable and necrotic hepatic tissue. Note the cytologic changes of hepatocellular injury in the viable tissue.
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fig3
Histology demonstrated massive hepatic necrosis, marked steatosis, widespread bile ductular proliferation, profound cholestasis, and necrotic vessels with intravascular thrombi (Figures 2 and 3).
First allograft (400x, H&E section): portal areas show areas of cholangitis. No features of acute cellular rejection. The parenchyma surrrounding this portal area appears viable.
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fig4
Biliary obstruction, vascular thromboses and infections, including cytomegalovirus, were excluded (Figure 4).
Explant of Allograft: 2531 g liver (expected weight 1500-1800 g) congested parenchyma with approximately 30% necrosis of the left lobe.
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fig5
Histology of the failed allograft demonstrated numerous areas of hemorrhagic necrosis; 30% of the left lobe was completely necrotic (Figures 5, 6, and 7).
Allograft (40x, H&E section).
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fig6
Histology of the failed allograft demonstrated numerous areas of hemorrhagic necrosis; 30% of the left lobe was completely necrotic (Figures 5, 6, and 7).
Allograft (100x, H&E section): higher power view of large zones of necrosis abutting adjacent viable hepatic tissue.
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fig7
Histology of the failed allograft demonstrated numerous areas of hemorrhagic necrosis; 30% of the left lobe was completely necrotic (Figures 5, 6, and 7).