Extended-donor criteria (EDC) liver allografts potentiate the role of procurement biopsy in organ utilization. To expedite allocation, histologic evaluation is routinely performed upon frozen-section (FS) specimens by local pathologists. This descriptive study compares FS reports by local pathologists with permanent-section (PS) evaluation by dedicated hepatopathologists, identifies histologic characteristics underrepresented by FS evaluation, and evaluates the efficacy of a biopsy decision analysis based on organ visualization. Fifty-two liver transplants using EDC allografts evaluated by FS with PS were studied. Pathologic worksheets created by an organ procurement organization were applied in 34 FS. PS analysis included 7 staining procedures for 8 histologic criteria. PS from 56 additional allografts determined not to require donor biopsy were also analyzed. A high correlation was observed between FS and PS. Underestimation of steatosis by FS was associated with allograft dysfunction. Surgical assessment of cholestasis, congestion, and steatosis was accurate whereas inflammation, necrosis, and fibrosis were underestimated in allografts suffering parenchymal injury. In conclusion, the correlation between FS and PS is high, and significant discrepancies are rare. Biopsy is not a prerequisite for EDC utilization but is suggested in hepatitis C, hypernatremia, donation after cardiac death, or multiple EDC indications. Implementation of a universal FS worksheet could standardize histologic reporting and facilitate data collection, allocation, and research. Liver Transpl 14: 639-646, 2008.
Transplantation-mediated alloimmune thrombocytopenia (TMAT) is donor-derived thrombocytopenia following solid-organ transplantation. To date, no clear consensus on the appropriateness of organ utilization from cadaver donors with a history of idiopathic thrombocytopenia purpura (ITP) has emerged. Herein is reported a devastating case of TMAT following liver transplantation utilizing an allograft from a donor with ITP that resulted in allograft failure. The literature is reviewed in this context to propose preliminary guidelines regarding utilization of allografts from cadaver donors with a history of ITP. Liver Transpl 14:1803-1809, 2008. © 2008 AASLD. Received January 22, 2008; accepted April 15, 2008.Donor-derived autoimmune disease following solidorgan transplantation has been described. 1-3 Morbidity results from allograft passenger lymphocytes remaining functional following transplantation. 1 Idiopathic thrombocytopenia purpura (ITP) is an autoimmune disorder characterized by autoantibody-mediated autologous platelet destruction. The principal antigens stimulating autoantibody production include platelet membrane-bound glycoproteins IIb and IIIa of the fibrinogen receptor, glycoprotein Ib/V/IX of the von Willebrand factor complex, and the platelet adhesin I glycoprotein. 4-11 Phagocytosis of autoantibody-coated platelets by the reticuloendothelial system incites thrombocytopenia. 4,12 Donor-derived thrombocytopenia from solid-organ transplantation is termed transplantation-mediated alloimmune thrombocytopenia (TMAT). 1,3 Previous authors have demonstrated that donor-origin antibodies produced by passenger B-cells are directed against the recipient platelet alloantigen [human platelet antigen 1a (HPA-1a)]. 1,3,8 A review of the English literature has revealed 3 cases of TMAT following orthotopic liver transplantation (OLT) 1-3 ; however, the implications, management, and outcomes of OLT recipients diagnosed with TMAT vary widely. No clear consensus on the appropriateness of organ utilization from a cadaver donor with a history of ITP has emerged.We report a devastating case of TMAT following OLT using an allograft from a donor with ITP. Thrombocytopenia was resistant to medical and surgical therapy, resulting in allograft failure from a massive subcapsular hematoma (Fig. 1). We review the literature in this context to
Background and Objectives:Meckel diverticulum can present with a variety of complications but is often found incidentally during other surgical procedures. The role of laparoscopy in the management of Meckel diverticulum is established. We reviewed our experience with complicated cases of Meckel diverticulum in children managed with laparoscopy.Methods:A 15-year retrospective chart review revealed 14 cases of complicated Meckel diverticulum managed with laparoscopy. Incidentally found Meckel diverticulum and cases done by laparotomy were excluded. Ages varied from 2 years to 16 years old. There were 10 males and four females. Eight cases had small bowel obstruction; of those, three had extensive intestinal gangrene. Four cases had significant rectal bleeding, three had acute diverticulitis, and two had intussusception caused by the diverticulum.Results:Eleven cases were treated with laparoscopic Meckel diverticulectomy and three with laparoscopic-assisted bowel resection because of extensive gangrene of the intestine. Two of the three cases with significant intestinal gangrene returned several weeks later with small bowel obstruction secondary to adhesions. They were successfully managed with laparoscopic lysis of adhesions. There were no other complications.Conclusions:Laparoscopy is safe and effective in the management of complicated Meckel diverticulum in children. Most cases can be managed with simple diverticulectomy. Laparoscopy is useful when the diagnosis is uncertain. When extensive gangrene is present, laparoscopy can help to mobilize the intestine and evaluate the degree of damage, irrigate and cleanse the peritoneal cavity, and minimize the incision necessary to accomplish the bowel resection.
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