Frozen Section Evaluation of Donor Liver for Transplantation
Frozen section evaluation of a donor liver is frequently performed to evaluate suitability for use
Is there fat?
Give percent of hepatocytes involved by macrovesicular (large droplet) fat
Severe macrovesicular steatosis is defined as involvement of >60% of parenchyma
Presence or absence of microvesicular fat should be commented on
Current standards based on evaluation of H&E stain, not fat stain
Is there underlying liver disease?
Rule out chronic hepatitis
If present, grade and stage
Is there evidence of malignancy?
Abundant lipofuscin may be seen in older donors
Severe macrovesicular fat or malignancy are contraindications for transplantation
Neeraja Kambham MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting : April 22, 2007
Macrovesicular fat is associated with primary non-function of graft
Severe steatosis (>60% of parenchyma) is a contraindication for transplant
Fatty livers are more sensitive to cold and warm ischemia
Reperfusion leads to disruption of hepatic microcirculation
Malignancy is a contraindication for transplant
Adam R, Reynes M, Johann M, Morino M, Astarcioglu I, Kafetzis I, Castaing D, Bismuth H. The outcome of steatotic grafts in liver transplantation. Transplant Proc. 1991 Feb;23(1 Pt 2):1538-40.
D'Alessandro AM, Kalayoglu M, Sollinger HW, Hoffmann RM, Reed A, Knechtle SJ, Pirsch JD, Hafez GR, Lorentzen D, Belzer FO. The predictive value of donor liver biopsies on the development of primary nonfunction after orthotopic liver transplantation. Transplant Proc. 1991 Feb;23(1 Pt 2):1536-7.