case_images: PMC10169701_01
case_images: (A) areas of necrosis were seen "N" contrasting with nucleated viable hepatocytes "V". Portal tracts demonstrated bile duct damage "BD" and endothelitis of portal vein branches "PV":features of acute rejection. The necrosis was only seen in this one biopsy. (B) Necrosis "N" was seen at one end of the biopsy, "V" marks viable cells with nuclei. Viable parenchyma showed features of acute hepatitis with acidophil bodies, top right, arrows. Portal tracts showed severe endothelitis in portal veins "PV" and severe inflammatory bile duct damage "BD":features of acute rejection. These changes, of necrosis and acute hepatitis, were only seen in this one biopsy of many taken from all allografts.
case_images: fped-11-1143051-g001.jpg
case_images: PMC10169701_01_fped-11-1143051-g001.jpg
case_images: F1
case_images: Histological features outwith the spectrum recognised in rejection were noted in the allografts (Figures 1A,B); patient 2 had acute haemorrhagic necrosis in her first allograft and patient 3 had an area of superimposed acute hepatitis of possible viral origin in her second allograft.
case_images: Line graphs of the alanine transferase (ALT), bilirubin and albumin levels at time points of "graft dysfunction", onset of persistent cholestasis and falling albumin levels for each patient.
case_images: fped-11-1143051-g002.jpg
case_images: PMC10169701_01_fped-11-1143051-g002.jpg
case_images: F2
case_images: Figure 2 shows timepoints of graft dysfunction, onset of persistent cholestasis and falling albumin levels for our patients in their post-transplant course. From a viral screen perspective,