The Role of Clinical and Morphological Factors in Evaluation of Donor Liver Suitability for Transplantation

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Abstract

To study the predictive value of intraoperative biopsies of the donor liver, we performed analysis of all cases of liver donation in Moscow for the period 01 January 2015 to 31 December 2016. The number of donors included in the study amounted to 228 people. All donors were certified of death by neurological criteria (brain death). Were formed 3 groups of donors. The control group consisted of 136 donors whose livers were explanted and successfully transplanted. The study group 1 was composed of 62 donors in whom livers were deemed unsuitable for transplant by cryostat sections of liver biopsy. The study group 2 (n2=30) included donors, which in the cryostat sections revealed contraindications to liver donation, but in the paraffin sections samples revealed that livers meet the criteria of suitability for transplantation. The morphological criteria of suitability included macrovesicular steatosis less than 60%, microvesicular steatosis of any degree of severity, fibrosis is not above class 2 by Knodell, necrosis of hepatocytes less than 10%.

Comparative analysis of the investigated groups revealed that the groups had no statistically significant difference by age (44,7; 47,6; 47,5; p=0,17), cause of death (stroke/TBI, p=0,12), values ALT1 and AST1 at admission (R=0,26, p=0.3 respectively), total bilirubin of blood before explantation (p=0.06), the dose and the nature of vasopressor support (p=0,09). There was a statistically significant difference between the groups in ALT2 and AST2 before explantation with the highest values in group 1 (p=0,03, p=0,03, respectively), the level of total bilirubin blood at admission with the highest values in the 1st and 2nd groups (p=0.001). Comparative analysis of the results of histological study revealed a statistically reliable difference in terms of "protein dystrophy of hepatocytes" with a predominance of severe degeneration in group 1, amounting to 34,8% (p=0.007), "macrovesicular steatosis" with the prevalence of steatosis exceeding 60% in group 1 (56,3%, p=0,0005), "fibrosis of portal tracts", class 2 according to Knodell was observed in 67.2 % of donors included in group 1.

Findings presented allow us to conclude that among all considered cases in 86.8% clinical and morphological data of the donor correlated, indicating a fairly high level of sensitivity of the method of frozen sections to assess the suitability of the donor liver for transplantation. In 30 cases (13,2%) visual and clinical assessment of liver transplant match criteria the suitability of the donor liver, but the final decision was made by the specialists of the transplant center on the basis of histological picture of the biopsy that had unsatisfactory features that led to the loss of viable donor organs under conditions of scarcity.

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