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Liver biopsy is important in the perioperative management of liver transplantation with regard to the preoperative evaluation of donor liver graft, especially to rule out steatotic liver, and the postoperative diagnosis of acute cellular rejection (ACR), especially to differentiate ACR from other causes of liver dysfunction. In both situations, liver biopsy is mandatory to confirm the diagnosis. The recent increases in metabolic syndrome and diabetes mellitus in the general population have led to an increased incidence of liver steatosis, even in donors without a history of excessive alcohol intake. Nonalcoholic fatty liver disease (NAFLD) includes a broad spectrum of liver injuries that resemble alcoholic hepatitis, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). NASH is the progressed stage of NAFLD and further progression results in fibrosis and cirrhosis, which might also be an indication for liver transplantation. ACR is one of the most serious adverse events after transplantation. It is often difficult to distinguish it from recurrent hepatitis C virus (HCV), and prompt treatment with an appropriate diagnosis is important. In this chapter, the indications for liver biopsy and the histologic findings for the diagnosis of NAFLD and ACR are described.

Liver Biopsy in Transplantation: Nonalcoholic Fatty Liver Disease and the Eosinophils