Reversibility of cirrhosis in thalassemia following hematopoietic cell transplantation

Serial liver biopsies illustrating reversibility of cirrhosis in a 25-year-old-female with thalassemia major, transfusional iron overload, and anti-hepatitis C virus antibodies. Panels A and B were obtained at the time of diagnosis of cirrhosis, four years after hematopoietic cell transplantation. Panel A (Masson trichrome stain) shows cirrhosis and active hepatitis; panel B (Perl's Prussian Blue reaction) shows severe iron overload (23 mg/g of liver dry weight). The liver biopsy shown on panels C and D was obtained 10 years after transplantation, four years following completion of phlebotomy treatment; abnormal aminotransferase levels normalized without antiviral treatment. It shows regression of cirrhosis, marked improvement of hepatitis, and absent iron overload (0.9 mg/g).