Introduction: Liver transplantation is a life-saving treatment for end-stage liver disease, but its success depends heavily on accurate pathologic assessment before, during, and after surgery. Pathology helps define native liver disease, assess donor organ quality, and identify causes of graft dysfunction. The aim of this study was to evaluate the pathologic findings in patients undergoing liver transplantation.

Material and methods: This retrospective descriptive cross-sectional study was conducted at Imam Reza Hospital, Tabriz, on 73 liver transplant patients selected by convenience sampling based on the Cochran formula. Data were extracted from archived medical records and pathology reports, and included demographic characteristics, transplant indications, explant pathology, and available post-transplant histopathologic findings to evaluate the spectrum of pathologic changes in this patient population.

Results: Among 73 liver transplant recipients, cirrhosis was the leading transplant indication (32.9%) and the dominant explant finding (71.2%), while advanced fibrosis/cirrhosis was present in 75.3%. Steatosis was identified in 31.5%, cholestasis in 23.3%, and hepatocellular carcinoma in 19.2%. Hepatocellular carcinoma was significantly associated with older age (P = 0.041), viral hepatitis (P = 0.018), pre-transplant cirrhosis (P = 0.047), dysplasia (P = 0.006), vascular abnormalities (P = 0.039), and microvascular invasion (P < 0.001).

Conclusion: These findings indicate that end-stage cirrhotic liver disease constitutes the principal pathologic burden in liver transplant recipients, while hepatocellular carcinoma represents a clinically important subset linked to adverse pathologic features. Careful explant pathologic evaluation is therefore essential not only for confirming the underlying disease spectrum but also for identifying malignant and high-risk microscopic characteristics with prognostic relevance.