title: Histology Utility in Liver Graft Surveillance: What About Normal Liver Tests?
abstract: BACKGROUND
  In liver transplantation, late graft dysfunction can have several causes, particularly rejection, infection, vascular, biliary complications, and others, usually suspected by abnormal liver tests. However, normal liver tests do not confirm a normal graft and liver biopsy could identify unexpected features with repercussions in immunosuppressive therapy. The aim of this study was to determinate the histological abnormalities in patients 10 years after liver allograft transplantation with sustainably normal liver tests and evaluate the changes in immunosuppressive therapy triggered by histological data.
  
  
  METHODS
  A retrospective analysis of liver allograft recipients was performed in an adult liver transplantation center with graft histological characterization 10 years after transplantation. Patients with abnormal liver tests and retransplantation were excluded.
  
  
  RESULTS
  We evaluated 39 patients with repeatedly normal liver tests. Familial amyloid polyneuropathy (n = 27) was the mainly indication for liver transplantation. Allograft histological dysfunction was observed in 13 (21.7%) patients. In 3 patients we observed chronic hepatitis, signs of cellular rejection in another 3 patients, and histological features suggesting autoimmune hepatitis in 7 patients. The diagnosis of de novo autoimmune hepatitis was proposed according to contemporaneous positive autoantibodies. Changes in immunosuppressive treatment were proposed in 7 patients.
  
  
  CONCLUSIONS
  Allograft histological dysfunctions 10 years after liver transplantation were observed in 21.7% of patients despite normal liver tests. Although the histological features led to alterations of immunosuppressive therapy in half of the cases, the absence of enzymatic tests changes makes monitoring a challenging process.
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal. Electronic address: saracp86@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Pereira
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: C M
authors.initials: CM
authors.lastname: Cruz
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Soares
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Gandara
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Ferreira
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: V
authors.initials: V
authors.lastname: Lopes
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Vizcaíno
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Daniel
authors.affiliation: Unidade de Transplante Hepático e Pancreático, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Instituto de Saúde Pública do Porto, Universidade do Porto, Porto, Portugal.
authors.forename: H P
authors.initials: HP
authors.lastname: Miranda
mesh_terms: D000328:Adult; D064591:Allografts / Q000473:pathology; D001706:Biopsy; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies