Advertisement

Intraoperative Assessment of Donor Livers in the Transplant Setting

  • Rhonda K. Yantiss
Chapter
Part of the Frozen Section Library book series (FROZEN)

Abstract

There are two major indications for intraoperative consultation on donor liver samples during, or prior to, transplantation surgery. Surgeons may encounter unsuspected hepatic tumors during the harvest of donor organs. These lesions must be classified as benign of malignant at the time of organ harvest, since a diagnosis of primary or secondary malignancy in the liver is a contraindication to transplantation of the liver, as well as most other organs from the donor. Donor livers are also evaluated by needle biopsy prior to transplantation in order to assess for the presence and extent of macrovesicular steatosis or severity of underlying liver disease. Excessive hepatic fat is a powerful predictor of suboptimal graft function during the perioperative period.

Keywords

Donor Liver Warm Ischemic Time Cold Ischemic Time Freeze Section Analysis Hepatocellular Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Busuttil RW, Tanaka K. The utility of marginal donors in liver transplantation. Liver Transpl. 2003;9(7):651–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Kauffman HM, McBride MA, Cherikh WS, Spain PC, Marks WH, Roza AM. Transplant tumor registry: donor related malignancies. Transplantation. 2002;74:358–62.CrossRefGoogle Scholar
  3. 3.
    Morath C, Schwenger V, Schmidt J, Zeier M. Transmission of malignancy with solid organ transplants. Transplantation. 2005;80:S164–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Loren AW, Desai S, Gorman RC, Schuchter LM. Retransplantation of a cardiac allograft inadvertantly harvested from a donor with malignant melanoma. Transplantation. 2003;76:741–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Stephens JK, Everson GT, Elliot CL, et al. Fatal transfer of malignant melanoma from multiorgan donor to four allograft recipients. Transplantation. 2000;70:232–6.PubMedGoogle Scholar
  6. 6.
    Buell JF, Gross TG, Woodle ES. Malignancy after transplantation. Transplantation. 2005;80:S254.PubMedCrossRefGoogle Scholar
  7. 7.
    Lipshutz GS, Baxter-Lowe LA, Nguyen T, Jones KD, Ascher NL, Feng S. Death from donor-transmitted malignancy despite emergency liver retransplantation. Liver Transpl. 2003;9:1102–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Takeda Y, Arii S, Kaido T, Niwano M, Moriga T, Mori A. Morphologic alteration of hepatocytes and sinuisoidal endothelial cells in rat fatty liver during cold preservation and the protective effect of hepatocyte growth factor. Transplantation. 1999;67:820–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Fukumori T, Ohkohchi N, Tsukamoto S, Satomi S. Why is fatty liver unsuitable for transplantation? Deterioration of mitochondrial ATP synthesis and sinusoidal structure during cold preservation of a liver with steatosis. Transpl Proc. 1997;29:412–5.CrossRefGoogle Scholar
  10. 10.
    Fishbein TM, Fiel MI, Emre S, et al. Use of livers with microvesicular fat safely expands the donor pool. Transplantation. 1997;64(2):248–51.PubMedCrossRefGoogle Scholar
  11. 11.
    Urena MAG, Ruiz-Delgado FC, Gonzalez EM, et al. Assessing risk of the use of livers with macro and microsteatosis in a liver transplant program. Transplant Proc. 1998;30:3288–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Adani GL, Baccarani U, Sainz-Barriga M, et al. The role of hepatic biopsy to detect macrovacuolar steatosis during liver procurement. Transplant Proc. 2006;38(5):1404–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Loinaz C, Gonzalez EM. Marginal donors in liver transplantation. Hepatogastroenterology. 2000;47(31):256–63.PubMedGoogle Scholar
  14. 14.
    Markin RS, Wisecarver JL, Radio SJ, et al. Frozen section evaluation of donor livers before transplantation. Transplantation. 1993;56(6):1403–9.PubMedCrossRefGoogle Scholar
  15. 15.
    D’Alessandro E, Calabrese F, Gringeri E, Valente M. Frozen-section diagnosis in donor livers: error rate estimation of steatosis degree. Transplant Proc. 2010;42:2226–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Cieslak B, Lewandowski Z, Urban M, Ziarkiewicz-Wroblewska B, Krawczyk M. Microvesicular liver graft steatosis as a risk factor for initial poor function in relation to suboptimal donor parameters. Transpl Proc. 2009;41(8):2985–8.CrossRefGoogle Scholar
  17. 17.
    Briceno J, Marchal T, Padillo J, Solorzano G, Pera C. Influence of marginal donors on liver preservation injury. Transplantation. 2002;74:522–6.CrossRefGoogle Scholar
  18. 18.
    Reich DJ, Hong JC. Current status of donation after cardiac death liver transplantation. Curr Opin Organ Transplant. 2010;15(3):316–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Kakizoe S, Yanaga K, Starzl TE, Demetris AJ. Frozen section of liver biopsy for evaluation of liver allografts. Transplant Proc. 1990;22(2):416–7.PubMedGoogle Scholar
  20. 20.
    Kakizoe S, Yanaga K, Starzl TE, Demetris AJ. Evaluation of protocol before transplanation and after reperfusion biopsies from human orthotopic liver allografts: considerations of preservation and early immunologic injury. Hepatology. 1990;11(6):932–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Zamboni F, Franchello A, David E, et al. Effect of macro-vesicular steatosis and other donor and recipient characteristics on the outcome of liver transplantation. Clin Transplant. 2001;15:53–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Velidedeoglu E, Desai NM, Campos L, et al. The outcome of liver grafts procured from hepatitis C-positive donors. Transplantation. 2002;73(4):582–7.CrossRefGoogle Scholar
  23. 23.
    Demetris AJ, Crawford JM, Minervini MI, et al. Transplantation pathology of the liver. In: Odze RD, Goldblum JR, editors. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Philadelphia: Saunders Elsevier; 2009. p. 1169–229.CrossRefGoogle Scholar
  24. 24.
    Jeon H, Lee S-G. Living donor liver transplantation. Curr Opin Organ Transplant. 2010;15:283–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Gruttadauria S, di Francesco F, Vizzini GB, et al. Early graft dysfunction following adult-to-adult living-related liver transplantation: predictive factors and outcomes. World J Gastroenterol. 2009;15(36):4556–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Bennett-Guerrero E, Feierman DE, Barclay GR, et al. Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation. Arch Surg. 2001;136:1177–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Bzeizi KI, Jalan R, Plevris JN, Hayes PC. Primary graft dysfunction after liver transplantation: from pathogenesis to prevention. Liver Transpl Surg. 1997;3(2):137–48.PubMedCrossRefGoogle Scholar
  28. 28.
    Hubscher SG, Portmann BC. Transplantation pathology. In: MacSween RNM, Burt AD, Portmann BC, Ishak KG, Scheuer PJ, Anthony PP, editors. Pathology of the liver. 4th ed. London: Churchill Livingstone; 2002. p. 885–941.Google Scholar
  29. 29.
    Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol. 1991;13:372–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineWeill Medical College of Cornell UniversityNew YorkUSA

Personalised recommendations