Prerecovery liver biopsy in the brain-dead donor: a case-control study of logistics, safety, precision, and utility.

Abstract

Prerecovery liver biopsy (PLB) can potentially to decrease futile recovery and increase utilization of marginal brain-dead donor (BDD) livers. A case-control study was conducted to examine the logistics, safety, histological precision, and liver utilization associated with PLB in BDDs. Twenty-three cases between January 2008 and January 2013 were compared to 2 groups: 48 sequential and 69 clinically matched controls. Compared to the sequential controls, the cases were older (53 versus 46 years), heavier (30.2 versus 25.8 kg/m2), had higher prevalences of hypertension (78.3% versus 44.7%) and alcohol use (56.5% versus 23.4%), and a lower United Network for Organ Sharing expected organ yield (0.73 versus 0.81 livers/donor; P < 0.05 for all). Baseline characteristics were similar between cases and clinical controls. Donor management time was longer for the cases (22.4 hours) versus sequential controls (16.5 hours, P = 0.01) and clinical controls (15.9 hours, P = 0.01). Complications for cases (8.7%) were not different from either group of controls (18.8% for sequential controls, P = 0.46; 17.4% for clinical controls, P = 0.50). The agreement between the donor hospital and study pathologists was substantial regarding evaluation of steatosis (κ = 0.623) and fibrosis (κ = 0.627) and moderate regarding inflammation (κ = 0.495). The proportions of livers that were transplanted were similar for the cases and the clinical controls (60.9% versus 59.4%). In contrast, the proportion of donors for whom liver recovery was not attempted was higher (30.4% versus 8.7%), and the proportion of attempted liver recoveries that did not result in transplantation was lower (8.7% versus 31.9%). These differences were significant at P = 0.009. Overall, PLB is logistically feasible with only a minimal delay and is safe, its interpretation at donor hospitals is reproducible, and it appears to decrease futile liver recovery.

• Authors: Joseph Benton Oliver, Stephen Peters, Advaith Bongu, Abdel-Kareem Beidas, George Dikdan, Lloyd Brown, Baburao Koneru
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 20 Issue 2 Pg. 237-44 (Feb 2014) ISSN: 1527-6473 [Electronic] United States
• PMID: 24382833 (Publication Type: Journal Article)
• Copyright: © 2013 American Association for the Study of Liver Diseases.

Topics

• Adult
• Biopsy
• Brain Death
• Case-Control Studies
• Fatty Liver (pathology)
• Female
• Humans
• Hypertension (pathology)
• Inflammation
• Liver (pathology)
• Liver Cirrhosis (pathology)
• Liver Transplantation
• Male
• Middle Aged
• New Jersey
• Observer Variation
• Reproducibility of Results
• Tissue Donors
• Tissue and Organ Harvesting (methods)
• Young Adult