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Hepatocellular proliferation and changes in microarchitecture of right lobe allografts in adult transplant recipients

Imaging studies show complete restoration of liver volume in adult recipients of right lobe allografts within 2–3 weeks of living donor transplantation (LDLT). However, it is not known if this growth is associated with restoration of hepatic microarchitecture. We compared 21 biopsies without significant pathology from LDLT recipients with 23 biopsies from adult recipients of cadaveric donor liver transplantation (CDLT) performed within 3 months of transplantation. The difference in the number of portal tracts per cm was statistically significant (P < .0001) between CDLT (9.08 ± 1.74) and LDLT recipients within 3 months (6.26 ± 1.62), as well as after 3 months following transplantation (6.56 ± 1.44). The coefficient of correlation between length of biopsy specimens and the number of portal tracts in these 3 groups was .94, .93, and .85, respectively. Proliferative activity demonstrated by immunohistochemical staining for MIB‐1 was seen predominantly in hepatocytes in both groups; bile ducts only occasionally stained positive. The difference between labeling indices of hepatocytes was statistically significant (P = .00056) between CDLT and LDLT recipients within 3 months of transplantation (.82 ± .63 and 4.53 ± 3.72), and between LDLT recipients within 3 weeks and after 3 weeks of transplantation (5.97 ± 3.78 and 1.80 ± 1.37, P = .0074). In conclusion, restoration of liver volume following LDLT occurs by proliferation of hepatocytes in the immediate posttransplant period. There is a decrease in number of portal tracts in these volume‐restored allografts. Volume restoration is therefore, not accompanied by restoration of hepatic microarchitecture. (Liver Transpl 2004;10:1461–1467.)