Postreperfusion Liver Biopsy as Predictor of Early Graft Dysfunction and Survival After Orthotopic Liver Transplantation

Abstract

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Prognostic value of the morphological features of postperfusion liver biopsies in liver transplantation

“…Our findings, especially the ones related to the prognostic effects of intrasinusoidal neutrophilic infiltration, are consistent with the literature, although hepatocellular necrosis which is one of the most common morphologic parameters shown to be associated with prognosis, was not found to be related to early hepatic dysfunction, mortality rate or rejection in our study. On the other hand, sinusoidal congestion, which is a finding that does not stand out in terms of prognostic value in studies in the literature except one study 11 , was found to be a more promising finding in the prediction of prognosis in our study. Another point to be noted is sinusoidal congestion is counted as one of the findings of hyperacute antibody mediated rejection (AMR) 16 , however none of our cases had the clinical findings of hyperacute AMR and showed very early graft loss.…”

“…In the other study, in which the presence of neutrophilic infiltrate was evaluated seperately in addition to IRI evaluation and the congestion was also examined, neutrophilic infiltrate was not associated with early graft dysfunction, while the presence of congestion was detected to be significantly related to early graft dysfunction. Besides, severe IRI was also shown to be significantly associated with shorter graft and patient survival 11 . In our study, unlike these studies, the possible prognostic effect of all morphological parameters that can be observed in postperfusion biopsies and that may be associated with IRI were evaluated separately.…”

“…The prognostic importance of severe IRI in postperfusion liver biopsies comes to the fore in the few recent publications with a high number of cases, focusing on the relationship between IRI and prognosis. In these studies, IRI was grouped as absent, minimal, mild, moderate and severe, mainly according to hepatocyte necrosis and neutrophilic infiltrate [11][12][13] . Takahiro et al, in their study with the highest number of cases on this subject with 506 cases, showed that the findings of moderate-tosevere IRI were an independent predictor of early graft dysfunction 13 .…”

“…The studies focusing on the relationship between the survival and primary graft dysfunction and certain morphological findings related to preservation injury in postperfusion biopsies such as intrasinusoidal neutrophilic infiltration, steatosis, hepatocyte swelling, hepatocellular necrosis, endothelial cell swelling, sinusoidal congestion/hemorrhage, epithelial changes in bile ducts and cholangiolar proliferation are limited and present controversial results 4,[6][7][8][9][10] . In a few recent studies in which the relation between the morphological features of ischemia-reperfusion injury (IRI) in postperfusion biopsies and prognosis was evaluated, it was shown that severe ischemia-reperfusion injury had negative effect on overall survival and graft survival 11,12,13 .…”

Hedgehog costimulation during ischemia-reperfusion injury potentiates cytokine and homing responses of CD4+ T cells

“…In an effort to increase organ availability, recent program changes to organ allocation have newly allowed tissues from suboptimal and geographically distant donors to become eligible for transplantation (6)(7)(8)(9). Post-hoc analyses showed that these newly eligible tissues were susceptible to developing IRI, and the cumulative prevalence of IRI has consequently risen by ~25% (10)(11)(12)(13). IRI is now estimated to affect between 40% and 50% of transplant recipients and is an increasing problem in the field of transplantation.…”