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Surgical Pathology Criteria

Frozen Section Evaluation of Donor Liver for Transplantation


  • Frozen section evaluation of a donor liver is frequently performed to evaluate suitability for use

Diagnostic Points

  • 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
    • Typically centrilobular
    • No significance
  • 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.
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