The Role of Post-Reperfusion Biopsy (PRB) in the Era of Extended Criteria Donor (ECD): Clinicopathologic Correlation and Follow-Up Analysis of 50 Liver Transplant Patients, a Prospective Study
M Raoufi, C Ma, A Ormsby, H Vakil, K Brown, MA Huang, D Moonka, M Abouljoud. Henry Ford Hospital, Detroit, MI; Wayne State University, Detroit, MI
Background: Organ shortage drives transplant surgeons to consider organs with extended criteria for transplant. A PRB at the time of transplant would serve the purpose of detecting existing pathology as well as obtaining baseline morphology for comparison with follow-up biopsies (FUBs). In this prospective study, we evaluate how and to what extent morphological changes in PRBs correlate with histologic findings in FUBs and clinical outcomes.
Design: Between January-July 2007, total of 50 liver transplants were performed in our center. Histologic sections of PRBs and FUBs (including H & E, trichrome and iron stains) were examined on a routine basis. All patients were followed till September 2008 and relevant clinical and laboratory data were recorded.
Results: Mean follow-up time was 518.4 days (range: 431-608). Mean time between PRB and FUBs was 94.9 days (SD + 120.62) for the first FUB (40 cases), 111.2 days (SD + 21.67) for the second FUB (16 cases), and 235 days (SD + 123.85) for the third FUB (8 cases). Major histologic findings in PRBs included: preservation injury (21 cases), macrovesicular steatosis (mild to moderate: 12 cases; severe: 4 cases), portal triad chronic inflammation and fibrosis (15 cases), and pericellular fibrosis (3 cases). Major histologic findings in FUBs included: acute cellular rejection (6 definite and 4 indeterminate cases), recurrent hepatitis C (6 cases), centrilobular necrosis (4 cases), and cholestasis (5 cases). After comparing pathological findings in PRBs and FUBs and correlating the findings with clinical and lab data, the following observations were made: 1) None of the major pathologic findings in PRBs persisted in FUBs, regardless of cause of end stage liver disease; 2) In patients with and without any type of pathology in PRBs, no significant differences were found in liver function tests, length of hospital stay, and survival rates.
Conclusions: Our experience indicates: 1) Transplanting organs with pre-existing pathologic changes does not adversely affect the outcomes, and 2) PRBs can reliably serve as a baseline measure of existing pathology in donor organs. Given the low morbidity of such biopsies and continued expansion of donor criteria, having PRB is appropriate to better understand the long-term impact of baseline pathologic findings.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 181, Tuesday Morning