Poor Correlation Between Pre-Transplant Visualized Estimate of Deceased Donor Liver Steatosis and Reperfusion Biopsy Assessment

Abstract

Purpose of Study: Pre-transplant deceased donor liver steatosis is estimated by the procuring surgeon by gross appearance of the organ, by a frozen section biopsy, or a combination of the two. This estimate is often the determining factor for the use or non-use of the organ. Permanent section biopsy of the reperfused liver may give a more accurate and reliable assessment of steatosis. This study assesses the correlation between the surgeons’ estimate of hepatic steatosis and the steatosis measured on permanent section biopsy from the reperfused liver. Methods Used: This study is a retrospective review of all deceased donor liver transplants at a single center over 5 years’ time. The surgeons’ estimates for all procured livers were recorded from the original on-site records from the organ procurement organization. There was no standardization to the reporting such that each recorded value reflected the estimate recorded by the on-site coordinator as stated by the procuring surgeon. All reperfusion biopsies were read by experienced liver transplant pathologists at a single center. A scatter plot with best fit line was utilized to determine correlation. Summary of Results: Data were available for 485 liver transplants. Correlation between the surgeon estimated steatosis and assessment by permanent biopsy was r2=0.26. The surgeon underestimated steatosis in 25 cases (5%), overestimated in 110 cases (23%), and was in agreement (+/- 5%) in 350 cases (72%). Conclusions: These results suggest a reasonable ability of the procuring surgeon to determine the presence of liver graft steatosis on site at the time of organ procurement, but the estimate of the extent of steatosis correlates poorly with that seen on permanent reperfusion biopsy.