Pathologic Criteria to Estimate the State of the Liver in Potential Multi-organ Donors with Brain Death

The aim of the investigation is to develop pathologic criteria to estimate the condition of the liver in potential multi-organ donors with brain death to decrease the subjectivity when excluding donor’s organs.

Materials and Methods. There has been carried out the histological study of 30 effective liver biopsy samples and 30 non-effective biopsy material of potential postmortal donors. Liver tissue sections were stained by hematoxylin and eosin, using Masson’s Trichrome staining, and PAS stain. To analyze histological material there have been used the computer quantitative morphometry system and statistical techniques.

Results. The protocol of morphological estimation of the liver of potential postmortal donor was developed. According to the protocol, donors’ liver pathology is to be estimated by eight histological criteria (steatosis, proteinosis and necrosis of hepatocytes; enotheliitis of central veins; endarteritis; phlebitis and inflammatory infiltration in portal tracts; hepatic fibrosis). Effective donors compared to non-effective ones were stated to have statistically significantly lower percentage of statosis (p<0.001), proteinosis (p<0.001) and necrosis of hepatocytes (p<0.001); and there were less expressed the degree of inflammatory infiltration (p<0.001), phlebitis (p=0.028) and endarteritis (p=0.028) in portal tracts and the degree of hepatic fibrosis (p<0.001).

1. Got'e S.V., Konstantinov B.A., Tsirul'nikova O.M. Transplantatsiya pecheni. Rukovodstvo dlya vrachey [Liver transplantation. Doctors’ Guide]. Moscow: OOO ″Meditsinskoe informatsionnoe agentstvo″; 2008; 248 р.
2. Ransford R., Gunson B., Mayer D. et al. Effect on outcome of the lengthening waiting list for liver transplantation. Gut 2000; 47: 441–443.
3. Demetris A.J., Ruppert K. Pathologist’s perspective on li­ver needle biopsy size? J Hepatol 2003; 39(2): 275–277.
4. Bravo A., Seth S., Chopra S. Liver biopsy. N Engl J Med 2001; 344: 495–500.
5. Ravaioli M., Grazi G.L., Cescon M. et al. Liver transplantations with donors aged 60 years and above: the low liver damage strategy. Transplant International 2009; 22(4): 423–433.
6. Fernandez-Merino F.J., Nuno-Garza J., Lopez-Hervas P. et al. Impact of donor, recipient and graft features on the development of primary dysfunction in liver transplants. Transplant Proc 2003; 35(5): 1793–1794.
7. Ijaz S., Yang W., Winslet M.C. et al. Impairment of hepatic microcirculation in fatty liver. Microcirculation 2003; 10(6): 447–456.
8. Verran D., Dilworth P., Tang P., McCaughan G. Use of severely steatotic grafts in liver transplantation. Ann Surg 2008; 248(1): 142–144.
9. Verran D., Kusyk T., Painter D. et al. Clinical experience gained from the use of 120 steatotic donor livers for orthotopic liver transplantation. Liver Transpl 2003; 9(5): 500–505.
10. Feng S. Steatotic livers for liver transplantation-life-saving but at a cost. Nat Clin Pract Gastroenterol Hepatol 2008; 5(7): 360–361.
11. Galankina I., Zimina L. Patologoanatomicheskie aspekty allotransplantirovannykh organov. V kn.: Transplantatsiya organov i tkaney v mnogoprofil’nom nauchnom tsentre [Anatomico-pathological aspects of allotransplantated organs. In: transplantation of organs and tissues in multi-type scientific centre]. Pod red. M.Sh. Khubutiya [M.Sh. Khubutiya (editor)]. Moscow: AirArt; 2011; р. 347–378.
12. Nepomnyashchikh D.L., Aydagulova S.V., Nepomnyashchikh G.I. Biopsiya pecheni: patomorfogenez khronicheskogo gepatita i tsirroza [Liver biopsy: pathomorphogenesis of chronic hepatitis and cirrhosis]. Moscow: Izdatel’stvo RAMN; 2006; 368 p.
13. Adani G.L., Baccarani U., Sainz-Barriga M. et al. The role of hepatic biopsy to detect macrovacuolar steatosis during liver procurement. Transplant Proc 2006; 38(5): 1404–1406.
14. Ermolov A.S., Chzhao A.V., Gulyaev V.A. et al. Hirurgiya. Zhurnal im. N.I. Pirogova 2006; 3: 72–77.
15. Saab S., Ghobrial R.M., Ibrahim A.B., Kunder G. et al. Hepatitis C positive grafts may be used in orthotopic liver transplantation: a matched analysis. Am J Transplant 2003; 3(9): 1167–1172.
16. Salizzoni M., Franchello A., Zamboni F. et al. Marginal grafts: finding the correct treatment for fatty livers. Transpl Int 2003; 16(7): 486–493.
17. Nocito A., El-Badry A.M., Clavien P.A. When is steatosis too much for transplantation? Hepatol 2006; 45(4): 494–499.
18. Bedossa P., Poynard T. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289–293.
19. Nekrasova T.P. Gepatologicheskiy forum [Hepatological forum]. Prilozhenie k zhurnalu ″Klinicheskaya farmakologiya i terapiya″ [Supplement to Journal ″Klinicheskaya farmakologiya i terapiya″] 2007; 2: 11–13.

Shkalova L.V., Zagainov V.E., Vasenin S.А., Minina М.G., Ilyinsky I.М., Tsirulnikova О.М. Pathologic Criteria to Estimate the State of the Liver in Potential Multi-organ Donors with Brain Death. Sovremennye tehnologii v medicine 2011; (4): 7