Allograft Liver Biopsy

Although not ideal, liver biopsy is the best available method for evaluation of the liver and is considered the gold standard. The most common use of liver biopsies in the posttransplantation setting is for diagnosis of allograft dysfunction presenting with abnormal liver chemistry tests. The causes of allograft dysfunction differ according to time. Early on, preservation and reperfusion injury, infection, donor-related disease, and acute rejection are more common. Later, disease recurrence, de novo disease, and chronic rejection are seen more frequently. A complete history and physical examination are followed by ultrasonography with Doppler. If biliary or vascular causes are suspected, further imaging is performed and stents or surgery planned. If these tests are not diagnostic, a liver biopsy is performed. In addition to diagnosis of allograft dysfunction, protocol liver biopsy can be helpful particularly to diagnose disease recurrence, particularly the immune-mediated diseases, as well as to evaluate the patient for eligibility for immunosuppression minimization and possible withdrawal. Given the risks and cost associated with liver biopsy, several methods are used for evaluation of fibrosis and rejection in the liver allograft. Although very promising, these methods have not been widely validated and are not ready for clinical use.  This review contains 9 figures, 2 tables, and 54 references.  Key Words: biopsy to diagnose allograft liver dysfunction, disease recurrence after liver transplant, immunosuppression withdrawal after liver transplant, liver biopsy to guide immunosuppression minimization, noninvasive methods to evaluate liver allograft, posttransplant diagnostic liver biopsy, preservation and reperfusion injury, protocol liver biopsy after transplant