Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients

Figure 1 Hemotoxylin-eosin stains of a core liver biopsy from a patient with venous outflow obstruction shows hemorrhage within sinusoidal spaces (A) as well as evidence of sinusoidal fibrosis on a trichrome stain (B).

Figure 2 Flowchart presenting number of treatments and recurrence of hepatic venous obstruction in all patients. HVOO: Hepatic venous obstruction; PTA: Percutaneous transluminal angioplasty.

Figure 3 Fifty years old woman with elevated LFTs after liver transplantation and biopsy findings of venous outflow obstruction found to have a right hepatic vein stenosis (A, arrow); following angioplasty with a 10 mm × 4 cm balloon (B), there was decrease in pressure gradient from 8 mmHg to 1 mmHg, though the venographic appearance remained the same (C, arrowhead). Late biopsy demonstrated no evidence of venous outflow obstruction and the patient was doing well at 1 year follow-up.

Figure 4 Sixty-six years old man with elevated LFTs after liver transplantation and biopsy consistent with venous outflow obstruction found with right hepatic vein stenosis (A, arrow); following angioplasty with 6, 8, 10, and 12 mm × 4 cm balloons (B), mild improvement was seen in luminal diameter on venography (C, arrowhead). On late biopsy, the patient had persistent evidence of venous outflow obstruction and repeat angioplasty was performed.