title: Utility of pre-procurement bedside liver biopsy in the deceased extended-criteria liver donor.
abstract: BACKGROUND
  The Indiana Organ Procurement Organization (IOPO) utilizes preoperative bedside liver biopsies in certain extended-criteria donors (ECDs), obtained by the on-site coordinator, to determine the utility of pursuing donation. This study reports the clinical and financial outcomes for this management strategy.
  
  
  METHODS
  All bedside liver biopsies obtained in ECDs over a five-yr period were reviewed. Study variables included the following: indication for biopsy, biopsy results, taking the case to the operating room, transplantation of the donor liver, and graft survival. All biopsies were processed at a single university center.
  
  
  RESULTS
  There were 110 donors biopsied. Primary indications included the following: old age (29%), extensive/current alcohol abuse (26%), hepatitis C-positive serology (21%), obesity (25%), and severely elevated liver function enzymes (18%). Biopsy results demonstrated a potentially transplantable liver in 73 cases (66%), all of whom were taken to the OR (while 37 ruled out for donation based upon liver biopsy [34%]). Of all biopsied livers, 49 ultimately were transplanted (45%). Intra-operative decisions included the following: transplant 51/73 (70%), surgeon decision to exclude 20/73 (27%), nonuse due to finding of malignancy two (3%).
  
  
  CONCLUSIONS
  Bedside liver biopsy may be a valuable tool to determine the utility in pursuing donation in ECDs, particularly with liver-only donors.
authors.affiliation: Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.forename: Tim C
authors.initials: TC
authors.lastname: Borup
authors.forename: Sam
authors.initials: S
authors.lastname: Popa
authors.forename: Romil
authors.initials: R
authors.lastname: Saxena
authors.forename: Oscar
authors.initials: O
authors.lastname: Cummings
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007196:Indiana; D008099:Liver / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000639:trends*; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000592:standards*; D055815:Young Adult
keywords: extended-criteria donor; liver biopsy; liver transplantation; organ procurement