Hepatic steatosis in organ donors – disparity between surgery and histology?

Aims: In times of organ shortage, use of marginal cadaveric livers has become of increased importance to reduce pressing organ demand and increased death rates while awaiting donations. Indisputably, fatty change in donor livers is a risk factor for poor initial function after orthotropic transplantation. However, identifying and rejecting marginal from good donor livers is one of the most difficult surgical tasks. Unfortunately, a liver biopsy and rapid histological diagnosis is rarely performed to identify marginal livers. Methods: From 2005 to 2008, we investigated 31 livers of organ donors, which were explanted but not transplanted or underwent liver wedge biopsy during organ donation. All livers underwent standard surgery proceedings and were allocated by Eurotransplant International Foundation. After unsuccessfully allocation, explanted livers were photographically documented, formalin-fixed and histopathologically analysed. Results: 5 livers were good organ quality classified by surgery (16%), 13 were acceptable (42%) and 13 poor (42%). In 47% of the livers, a frozen section was performed. 6 of 31 cases (19%) showed macrovesicular and microvesicular steatosis less than 10%. In addition, all 6 cases fulfilled 2 or less extended donor criteria, as defined by the German Medical Association. Conclusion: More marginal livers from cadaveric organ donors could be transplanted. To extend the transplant pool of liver grafts, liver biopsies should be performed in all cases of poor and acceptable liver grading by surgery. If frozen section analysis is performed, a wedge liver biopsy should be taken from at least two different segments of liver to validate histological results.

liver biopsy - organ donor - steatosis hepatis