الفهرس 
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Abstract
Liver transplantation (LT) should be considered in any patient with end-stage liver disease, in whom the LT would extend life expectancy beyond what the natural history of underlying liver disease would predict or in whom LT is likely to improve the quality of life (QoL) (Vama et al., 2011) .
Liver biopsy revealed a high prevalence of histological abnormalities, so it impacted proper therapeutic management, particularly with respect to immunosuppressive and antiviral therapy (Sebagh et al., 2012 ) .
The aim of the work was to study the result of liver biopsy post liver transplantation, and its correlation with clinical status of recipients. We also assess the outcome of LT patients with particular emphasis on liver graft function and histology.
To achieve this aim, our study was conducted on all liver transplant recipients who attended the liver transplant clinic, National Liver Institute, Menoufiya University from 2003 to September 2015 .
Total number of patients was 198 patients , 99 patients died early after operation and the other 99 patients were still alive .Ten of them had no follow up data after liver transplantation as they were out of Egypt .
The remaining 89 patients were classified into two groups:-
group 1 :- Thirty four patient underwent liver biopsy.
group 2 :- Fifty five patient did not undergo liver biopsy All patients in this study were subjected to the following during their follow up and emphasizing on: liver tests , renal test , complete blood count , immunosuppressive drug , liver biopsy and its result .
We found that :-
- As regards age :- the mean± SD in patients with biopsy was (44.65 ± 8.46) years old while in patients with no biopsy was (47 ± 8.743) years old .
- As regards sex :- male patients represented 88.2% in patients with biopsy while they represented 94.5% in patients with no biopsy .
- As regarding date from liver transplantation till biopsy (months) :-
Median was (19) and range was (4-14) .
- As regards indication of liver transplantation among all studied patients :- decompensated liver cirrhosis post hepatitis c virus infection was the most common indication in both groups as it represented 61.8% in patients who underwent liver biopsy while it represented 50.9% in patients who did not undergo liver biopsy .The second indication was hepatocellular carcinoma as it represented 32.4% in patients who underwent liver biopsy while it represented 36.4% in patients who did not undergo liver biopsy . The other causes was related to primary sclerosing cholangitis, autoimmune hepatitis, chronic HBV and primary biliary cirrhosis .
- As regards histopathological findings revealed by liver biopsy :- chronic viral hepatitis was the commonest finding as it represented (50%) followed by acute rejection (20.6%) , steatohepatitis (11.8%) , chronic rejection and chronic hepatitis each (5.9%) then cholestasis and CMV infection each represented (2.9%) .
- As regards median of date (months) from transplantation till occurrence of histopathological picture revealed by liver biopsy :-
there was no statistically difference in the median of date from liver transplantation till biopsy as regarding histopathological outcome .
- As regards comparing the median of laboratory findings with the different histopathologic outcome :- alkaline phosphatase was highly elevated in cholestasis and CMV infection and it was statistically significant (p=0.012) . GGT also was gross elevated in both conditions but it was statistically insignificant (p=0.055) . AST level was high in chronic rejection than other finding but it was statistically insignificant (p=0.062) .
- As regards outcome of patients who managed according to liver biopsy in contrast with patients who did not undergo liver biopsy :- 32 patients who managed by liver biopsy (94.1%) got score A while 2 patients got score B (5.9%) according to child pugh classification , while 51 patients who did not undergo liver biopsy (92.7%) got score A while 4 patients (7.3%) got score B .
-As regards patients who underwent recurrent biopsies :- nine patients underwent recurrent biopsy , four of them underwent two biopsies while the other five underwent three biopsies . the four patients who underwent two biopsy , two patients revealed the same histopathological picture in both biopsy with percentage of 50% while the other two patients show different histopathological picture in both biopsy with percentage of 50% . Five patients who underwent three biopsies , two patients of them showed the same histopathological picture in both 1st and 2nd biopsy with percentage of 40% . The five patients revealed completely different histopathological picture in 3rd biopsy from that of 1st and 2nd biopsy .