Liver biopsy and postmortem findings in a recipient of HSCT with FA and with PLI. Shown are representative images from serial liver biopsy samples and postmortem analysis of liver sample in a recipient of HSCT with FA and with PLI. The patient had a liver biopsy at 15 years after HSCT to investigate transaminitis. (A-B) H&E staining shows inflammation of the portal tracts with associated cholangitis and pericholangitis and reactive changes in the bile ducts. Bridging fibrosis and focal nodule formation are seen. The patient had a repeat liver biopsy at 16-years post-HSCT. (C-D) Hematoxylin and eosin staining demonstrates acute cholangitis and pericholangitis with lobular cholestasis. Extensive fibrosis of the portal tracts is again seen. Postmortem examination of the liver, 1 year later (E-F) shows marked nodular hyperplasia, fibrosis, and ischemia. The portal tracts show reactive expansion secondary to mononuclear infiltrates and associated cholangitis and pericholangitis. (G-H) Trichrome staining shows portal to portal bridging fibrosis with a prominent perisinusoidal component. (I-J) CK7 immunostaining shows ductular proliferation with ectopic staining of hepatocytes.