1. The histopathologic presentation of
hepatitis B (HB)
infection in liver allografts is generally similar to that seen in the nonallografts. 2. An atypical pattern of recurrent HB, i.e., fibrosing cholestatic
hepatitis (FCH) occurs in a small number of patients. These patients present with a severe cholestatic syndrome, which may clinically resemble acute or chronic rejection. 3. There are several other possible causes of acute and
chronic hepatitis in liver allografts that may need to be considered. 4. Hepatitis B virus (HBV)
infection in the liver allograft can easily be confirmed by performing immunohistochemical stains for
hepatitis B surface antigen (
HBsAg) and
hepatitis B core antigen (
HBcAg). The expression pattern of these HBV
antigens varies and is sometimes helpful in determining whether the liver injury is mainly from the HBV or from other causes in coexistence with the HBV
infection. 5. Histological grading of the necroinflammatory activity and staging of the
fibrosis should only be applied when the changes are related to the recurrent HB. 6. The pathology of
liver transplantation is complex; therefore, clinical correlations remain extremely important in arriving at the final and correct diagnosis.