Approach to intraoperative consultation for donor liver biopsies.
BACKGROUND
As demand for organs to treat end-stage liver disease increases, donor livers once deemed only marginally suitable for donation are being considered for transplantation. Pathologists are increasingly being asked to evaluate these livers for acceptability. This article provides guidelines for frozen section evaluation of livers for transplantation.


OBJECTIVE
This article concentrates on the histopathologic features of transplant suitability with appropriate clinicopathologic correlation for the practicing pathologist. Recommendations for proper handling and sampling of tissue are discussed. Relative and absolute contraindications as well as artifacts and benign conditions are emphasized.


METHODS
Sources include a compilation of the authors' experiences in academic and community liver transplantation centers. In addition, relevant medical literature was reviewed, as well as Web sites specializing in organ transplantation, such as Transplant Pathology Internet Services and the Organ Procurement and Transplantation Network.


CONCLUSIONS
Malignancy and extensive necrosis in the liver are absolute contraindications to transplantation. Evaluation of macrosteatosis, fibrosis, hepatitis, and necrosis depends on the severity of disease and correlation with the clinical situation. Donor age of greater than 60 years does not preclude transplantation. Artifacts and benign conditions need to be understood to prevent wastage of precious organs and to ensure that an appropriate organ is provided for the recipient.
School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
Claire
C
Melin
Ronald
R
Miick
Nancy A
NA
Young
Jorge
J
Ortiz
Manjula
M
Balasubramanian
D001706:Biopsy; D000075202:Contraindications; D046148:Donor Selection; D005234:Fatty Liver / Q000473:pathology; D020518:Focal Nodular Hyperplasia / Q000473:pathology; D005629:Frozen Sections; D019698:Hepatitis C, Chronic / Q000473:pathology; D006801:Humans; D007432:Intraoperative Period; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects / Q000473:pathology; D019520:Living Donors; D009336:Necrosis; D010340:Pathology, Surgical; D012017:Referral and Consultation; D012307:Risk Factors; D012806:Siderosis / Q000473:pathology; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting