Introduction: The spectrum of diseases encountered in post-transplant liver biopsies is broad. The pathologist plays an important role in defining these process. 

Aim: The aim of this study was to evaluate liver allograft biopsies performed for graft dysfunction by analysing the pattern of injury and intensity, and the timeline of occurrence of graft dysfunction. The pathological features of explant liver of these patients were also looked into.

Materials and Methods: Retrospective study was carried out on 110 liver allograft biopsies from 65 patients and their histological findings with clinical presentation were correlated. The period of study was from January 2013 to December 2016. 

Results: The most common histological lesion was preservation-reperfusion injury (PRI) in 40 (36.36%) biopsies followed by acute cellular rejection (ACR) in 32(29.09%) biopsies. Biliary obstruction, sepsis and chronic rejection was present in 5 (4.55%) biopsies each. Five biopsies (4.55%) showed idiopathic posttransplant hepatitis. Steatohepatitis and ischemic necrosis were seen in 4 (3.64%) cases each. Three biopsies (2.73%) showed acute cholangitis. Recurrence of HCV was reported in 1 (0.91%) case and HBV reactivation in one (0.91%) case. Nonspecific changes like focal mild lobular and focal portal inflammation and mild steatosis were present in 4 (3.64%) cases.

Conclusion: Reperfusion injury ( PRI ) in time zero biopsies was the most common finding in our study followed by ACR. 70.9% of biopsies with ACR were observed within 6 months post transplant. Analysis of explant liver specimens showed cirrhosis associated with alcoholic steatohepatitis to be the most common etiology of end stage liver disease leading to transplant. 

Keywords: Reperfusion Injury; Acute Cellular Rejection; Chronic Rejection; Explant; Transplant.