Utility of liver allograft biopsy obtained at procurement.
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.
Lo
Irene J
IJ
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. jfr2103@columbia.edu
Lefkowitch
Jay H
JH
Feirt
Nikki
N
Alkofer
Barbara
B
Kin
Cindy
C
Samstein
Benjamin
B
Guarrera
James V
JV
Renz
John F
JF
D000328:Adult; D001706:Biopsy; D005629:Frozen Sections; D015276:Health Care Rationing / Q000458:organization & administration*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000473:pathology*; D016031:Liver Transplantation; D008499:Medical Records; D010338:Pathology, Clinical / Q000458:organization & administration*; D018579:Patient Selection; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013194:Staining and Labeling; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014184:Transplantation, Homologous; D014481:United States