Utility of liver allograft biopsy obtained at procurement

Abstract

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.

The Use of Fatty Liver Grafts in Modern Allocation Systems

“…[30][31][32] This strategy is based on the rationale that healthier recipients could better tolerate a poor initial graft function or major postoperative complications. [33][34][35] Underlining this thesis, we have previously reported a series of 20 patients enjoying an excellent outcome despite the use of steatotic grafts, in great part related to the selection of recipients presenting with a low model for end-stage liver disease score.…”

Liver transplantation using fatty livers: Always feasible?

“…In addition, a recent study confirmed that H&E-stained frozen biopsy overestimates MiS but underestimates MaS, when compared with permanent sections using more specific staining modality [23]. Therefore, it can be argued that a significant bias in most studies investigating fatty livers has been the use of only H&E-stained frozen biopsy specimens [13].…”

Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

“…It also appears to be preferable for cadaveric donors because it implies a substantial reduction of the cold ischemia time in comparison with routine histopathological processing. 7 The main limitation ascribed to the frozen-section procedure is represented by the risk of underestimating macrosteatosis while overestimating microsteatosis due to the presence of water droplets entrapped in hepato-cytes at the time of tissue freezing. Nonetheless, we recently reported that the frozen-section evaluation of pretransplant liver biopsies led to the successful utilization of livers from donors Ͼ 60 years old.…”