Demetris, AJ

Kakizoe, S

Starzl, TE

Yanaga, K

PubMed

D-Scholarship@Pitt

Frozen Section of Liver Biopsy for the Evaluation of Liver Allografts S. Kakizoe, K. Yanaga, T.E. Starzl, and A.J. Demetris INTRODUCTION THE success of liver transplantation has resulted in an increased rate of harvesting of donor organs, some of which may have an abnormal gross appearance or are taken from unstable or nonheart-beating donors. I The pathologist may be requested to assist in the evaluation of the organ's suitability for transplantation. The following is a synopsis of the experience at the University of Pittsburgh with the pathologic evaluation of donor organs by gross inspection and frozen section evaluation. MATERIALS AND METHODS Thirty-eight of 594 donor livers harvested betw«n January 1988 and February 1989 and preserved with rniversll~ of Wisconsin solution were evaluated by a pathologist before Implantation at the request of the donor and recipient surgeon. All the donor livers were examined grossly and frozen section biopsy evaluation was performed in each case. Twenty-seven of the 38 organs evaluated were not used (Table I I: 21 of these" ere steatotic. 4 had' 'reactive" hepatitis. one hepatocellular swelling. and one had an intrinsic arterial wall defect due to arthrogrypoSIS multiplex. Eleven of the grafts examined by the pathologJst were trans· planted after the evaluation. The grafts used for transplantation after pathokDg~ evaluation were followed for I month after Implantation and ~Mmpared with 34 contemporaneous controls. where' 'backtable" t-iopsles were performed but processed routinely and evaluated only after transplantation.; Donor variable examined in both groups were age. sex. body weight. alcohol or drug history. ~;iuse of death. days in leu before procurement. history of carlf;i~ arrest. and preservation time. RESULTS Two of the II (18q.) organs transplanted after pathologic evaluation failed within the first postoperative month. both because of severe Ischemic injury. presumat-Iy incurred during preservation or implantation. Frozen ~ection eval-r.ble 1. Summ.ry of HIstologIc FIndings Unused' U&eCI' HIstOlogIC FIndIngs (n = 27) (n • ,') -;';,-lrOI' In = 34) Severe steatosIS 13 0 Mild to moderate steatosIS 8 2 Hepatocellular swelling 1 Reactive hepatitiS 4 1 Benign tumorous leSIon 0 2 Anomaly 1 0 No pathologIC change 0 5 'Gralls _e used lor research purposes aher FLBx evalualJO" 'Gralls _e Iransplanled atler FLBx evaluallOn 0 11 7 6 0 0 10 'Gralls were 1IoOps!8d dunng DacklaDle preparatIOn Out lhe ~ '.les were re· VIewed aner ltansQlanlatlOtl 416 uation of these two grafts revealed only mild microvesic-ular steatosis. Four of the 34 contemporaneous controls failed and:! of these patients died. Ischemic "preserva-tion" injury was thought to be responsible for two of these failures and sepsis and esophageal perforation in the oth-ers. The difference in the rate of graft failure was not statistically significant. The only significant difference in donor variables noted between the two groups was the incidence of obesity (> l5o/c overweight) (unused grafts vs controls: 13::!7 vs 4/34) and history of alcohol abuse in the donors. DISCUSSION Frozen sectIOn evaluation has been used at Pittsburgh to evaluate donor organs since several grafts that contained severe macrovesicular steatosis were transplanted and failed shortly thereafter. 3 We have had experience with one additional case since the original report as have others.4 all of which have failed in a similar fashion. We therefore feel justified in diverting these organs for re-search purposes. By contrast. 12 of the organs were discarded because of mild to moderate steatosis or "reac· tive" hepatitis: lesions which were present In biopsies from the control population were associated with livers that functioned normally after transplantation. The final decision to use the organs or to divert them for research rested with the recipient surgeon but was influ· enced by the histology in some cases. In several instances where the pathology was only minimall\ abnormal. the recipient surgeon \l.3S wary of apparently unfavorable events that occurred dunng the agonal stages in the donor. and was searching for additional objective data to abort the procedure. In other,. the deciSion to abort the procedure despite a relatively good histologic appearance was based on cold ischemia prolonged to more than ~S hours. In none of these cases \I. as the decision based purely on the histology. other than those wllh severe macrovesicular steatosis. Finally. it should be emphasized that all organs selected for biopsy e\aluatlon were considered suspect because of gross phYSical alterations or an unfavorable history in the donor. After frozen section screentng, the rate of graft From the [)epanments of Pathology (S.K .. A.J.D.) and Surgery (K.Y.. T.E.S.). Presbytenan UniverSity Hospital. UniverSity of Pins· burgh. Pinsburgr.. Pennsylvania. Address repnnt reQuests to A.J. Demetris. MD. Pathology Department. Presbyterian UnIVerSity Hospital of Pinsburgh. De Soto at O'Hara Streets. Plnsburgh. PA 15213. c 1 990 by Appleton & Lange 0041-134590 S3 00 ·0 Transplantation Proceedmgs. Vol 22. No 2 (Apnl). 1990: pp 416-417 ._-------_._-_._ .. FROZEN SECTION OF LIVER BIOPSY FOR THE EVALUATION OF LIVER ALLOGRAFTS 417 failure after transplantation was similar in those evaluated and in the controls. We assume that all 13 of the grafts" ith severe steatosis would have failed based on our previous experience; however. in the absence of obvious features that would disqualify the organ. the pathology evaluatil'n was unable to predict the adequacy of organ function after transplantation in those livers with minimal pathologic changes. Frozen section evaluation was also valuable for the diagnosis of tumorous lesions. Nodular regenerative h~­perplasia and biliary cysts have been identified pathologl-cally. None of the donor livers with these lesions have caused complications after 10 months of follow-up. REFERENCES I. Ericzon BG. Lundgren G. Wilczek H. Groth CG: Transplant Proc 19:3862. 1987 2. Yanaga K. Makowka L: Clin Transplant (in press) 3. Todo S. Demetris AJ. Makowka L. et al: Transplantation 47:903. 1989 4. Portmann B, Wight DGD: In: Caine R. ed. Liver transplan-tation: the Cambridge King's college Hospital experience. Or-lando. FL: Grune & Stratton 1987:437 

Frozen section of liver biopsy for the evaluation of liver allografts

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Frozen section of liver biopsy for the evaluation of liver allografts

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