title: Prerecovery liver biopsy in the brain-dead donor: a case-control study of logistics, safety, precision, and utility.
abstract: Prerecovery liver biopsy (PLB) can potentially to decrease futile recovery and increase utilization of marginal brain-dead donor (BDD) livers. A case-control study was conducted to examine the logistics, safety, histological precision, and liver utilization associated with PLB in BDDs. Twenty-three cases between January 2008 and January 2013 were compared to 2 groups: 48 sequential and 69 clinically matched controls. Compared to the sequential controls, the cases were older (53 versus 46 years), heavier (30.2 versus 25.8 kg/m2), had higher prevalences of hypertension (78.3% versus 44.7%) and alcohol use (56.5% versus 23.4%), and a lower United Network for Organ Sharing expected organ yield (0.73 versus 0.81 livers/donor; P < 0.05 for all). Baseline characteristics were similar between cases and clinical controls. Donor management time was longer for the cases (22.4 hours) versus sequential controls (16.5 hours, P = 0.01) and clinical controls (15.9 hours, P = 0.01). Complications for cases (8.7%) were not different from either group of controls (18.8% for sequential controls, P = 0.46; 17.4% for clinical controls, P = 0.50). The agreement between the donor hospital and study pathologists was substantial regarding evaluation of steatosis (κ = 0.623) and fibrosis (κ = 0.627) and moderate regarding inflammation (κ = 0.495). The proportions of livers that were transplanted were similar for the cases and the clinical controls (60.9% versus 59.4%). In contrast, the proportion of donors for whom liver recovery was not attempted was higher (30.4% versus 8.7%), and the proportion of attempted liver recoveries that did not result in transplantation was lower (8.7% versus 31.9%). These differences were significant at P = 0.009. Overall, PLB is logistically feasible with only a minimal delay and is safe, its interpretation at donor hospitals is reproducible, and it appears to decrease futile liver recovery.
authors.affiliation: Departments of Surgery, Rutgers-New Jersey Medical School, Newark, NJ.
authors.forename: Joseph Benton
authors.initials: JB
authors.lastname: Oliver
authors.forename: Stephen
authors.initials: S
authors.lastname: Peters
authors.forename: Advaith
authors.initials: A
authors.lastname: Bongu
authors.forename: Abdel-Kareem
authors.initials: AK
authors.lastname: Beidas
authors.forename: George
authors.initials: G
authors.lastname: Dikdan
authors.forename: Lloyd
authors.initials: L
authors.lastname: Brown
authors.forename: Baburao
authors.initials: B
authors.lastname: Koneru
mesh_terms: D000328:Adult; D001706:Biopsy; D001926:Brain Death; D016022:Case-Control Studies; D005234:Fatty Liver / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000473:pathology; D007249:Inflammation; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D015588:Observer Variation; D015203:Reproducibility of Results; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D055815:Young Adult