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. 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. 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. In conclusion, 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.
Volume : 6
Issue : 4
Pages : 8
Division of Transplantation Surgery, Henry Ford Hospital, Detroit, Michigan, USA