Reliability of frozen section in the assessment of allograft steatosis in liver transplantation.
BACKGROUND
Because liver allograft steatosis is an important risk factor of graft dysfunction after liver transplantation, it must be taken into consideration during graft acceptance. The aim of this study was to evaluate the reliability of frozen section in the assessment of liver steatosis before transplantation.


METHODS
The retrospective analysis was based on data of 112 liver allograft procurements performed between 2003 and 2012. Hepatic steatosis was assessed in frozen and routine sections. Sensitivity, specificity, and positive and negative predictive values of the frozen section were evaluated with respect to detection of >30% and >50% steatosis.


RESULTS
According to routine section assessment, there were 32 (28.6%) cases of steatosis >30% and 16 (14.3%) of >50%. The results of frozen section assessment were underestimated and overestimated in a similar low number of cases, both for the >30% (0.0% and 0.9%, respectively, P < 1.000) and the >50% (4.5% and 0.9%, respectively, P = .221) cutoff. Sensitivity, specificity, positive and negative predictive values of frozen section assessment were 100.0%, 98.8%, 97.0%, and 100.0%, respectively, for detection of >30% steatosis, and 68.8%, 99.0%, 91.7%, and 95.0%, respectively, for >50% steatosis.


CONCLUSIONS
Considering high positive predictive value of frozen section assessment in detection of >50% steatosis, it may serve as a base to discard the use of graft for transplantation. However, according to the relatively moderate sensitivity of this method, decision of graft acceptance must also be made on consideration of other well-known factors for poor posttransplant function.
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. Electronic address: holowko.waclaw@gmail.com.
W
W
Hołówko
Department of Pathological Anatomy, Medical University of Warsaw, Warsaw, Poland.
M
M
Mazurkiewicz
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Grąt
Department of Pathological Anatomy, Medical University of Warsaw, Warsaw, Poland.
L
L
Koperski
Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland.
Z
Z
Lewandowski
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
P
P
Smoter
Department of Pathological Anatomy, Medical University of Warsaw, Warsaw, Poland.
B
B
Ziarkiewicz-Wróblewska
Department of Pathological Anatomy, Medical University of Warsaw, Warsaw, Poland.
B
B
Górnicka
Department of Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland.
H
H
Zborowska
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Krawczyk
D000328:Adult; D000368:Aged; D064591:Allografts / Q000473:pathology*; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D005629:Frozen Sections; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000209:etiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity