Histology:
Histologically, SASS has been noted to demonstrate cholestasis, epithelial ductal regressive changes, and centrilobular zone necrosis (1,11,12,13). If transplant biopsy were performed, SASS generally demonstrates mild inflammation, which contrasts with the overt findings seen during acute rejection (1). Potential consequences of SASS feature early graft dysfunction and biliary ischemia, potentially leading to re-transplantation (2,4).
Some institutions perform either prophylactic or post-transplant treatment procedures in up to 25% of all transplant patients (4). The outcome of SASS depends on the time since the hepatic artery suffered ischemia. Therefore, it is necessary to diagnose and treat the complication as soon as possible (14). The diagnosis of SASS is particularly challenging as it has nonspecific signs such as elevated LFTs, cholestasis and graft dysfunction (14).