Vascular outflow obstruction changes and low prevalence of advanced fibrosis characterize the liver pathology in orthotopic heart transplant recipients

Objective The number of orthotopic heart transplants (OHTs) performed each year continues to increase, as does the post-transplant survival rate. Little is known, however, about the morphologic changes in the liver after the patient has undergone an OHT. In this study, we retrospectively reviewed liver pathology in patients following OHT to comprehensively describe the histopathologic changes, particularly fibrosis. Methods Three pathologists retrospectively reviewed liver biopsy samples in patients who had undergone OHT using a standardized checklist format. Results In our cohort of 19 biopsies, the morphologic features of hepatic injury noted were in the form of vascular outflow obstruction (9 biopsies), portal inflammation (13 biopsies), cholestasis (8 biopsies), and steatosis/steatohepatitis (5 biopsies). There was no evidence of nodular regenerative hyperplasia. Five of 9 patients with vascular outflow obstruction had sinusoidal fibrosis. Of 8 patients with clinical suspicion of portal hypertension and cirrhosis, only 3 demonstrated advanced fibrosis. Conclusions This is the first comprehensive account of histopathologic changes in the liver following OHT. This information will be beneficial for clinical decision-making when monitoring hepatic function and fibrosis in patients with OHT.