Fast Chromotrope Aniline Blue Special Stain Is a Useful Tool to Assess Fibrosis on Liver Biopsy During Transplantation

The histological assessment of liver fibrosis in grafts from extended criteria donors predicts the outcome after liver transplantation: A retrospective study

BACKGROUND

The use of extended criteria donors (ECD) in liver transplantation is increasing due to the organ shortage. Histological evaluation of the liver graft in the context of procurement is an important tool for extending the donor pool without affecting the quality of the transplanted organs. Macrovesicular steatosis is widely accepted as predictor of early allograft dysfunction (EAD), while other features, such as portal fibrosis, are poorly studied.

AIM

To identify morphological features, other than macrovesicular steatosis, that may affect recipients' outcome.

METHODS

Between 2014 and 2016, 132 donors with extended criteria underwent pre-transplant liver biopsy during procurement. Histological variables of the graft, donors'/recipients' clinical data, EAD and patient/graft survival were registered.

RESULTS

The recipients who received a graft with histological-proven portal fibrosis had a significant lower patient and graft survival in comparison to patients without fibrosis (P = 0.044 and P = 0.039, respectively). Donors' dyslipidemia was significantly associated with the occurrence of EAD (P = 0.021). When dyslipidemia was combined with histological liver fibrosis a 54.5% incidence of EAD was observed (P = 0.012).

CONCLUSIONS

The histological assessment of liver fibrosis in pre-transplant biopsy of ECD grafts, together with donor's clinical data, provides important information on recipients' outcome.

Anti-inflammatory and hepatoprotective effects of exopolysaccharides isolated from Pleurotus geesteranus on alcohol-induced liver injury

The present work investigated the hepatoprotective role of exopolysaccharides (EPS) isolated from the mushroom Pleurotus geesteranus with respect to alcohol-induced liver injury in mice. Based on a physico-chemical analysis, the EPS produced by Pleurotus geesteranus was identified as a heteropolysaccharide with α-glycosidic bond. The results revealed that prophylactic application of the EPS reduces detrimental alcoholic effects on the liver. This observation was followed by decreased levels of total cholesterol, triglycerides, CYP2E1 and pro-inflammatory mediators (TNF-α, IL-6, IL-1β, COX-2, NO and iNOS) in the liver homogenates, suggesting that the EPS exhibits anti-inflammatory and hepatoprotective effects. Moreover, the increased activity of hepatic enzymes (superoxide dismutase, glutathione peroxidase and catalase) and reduced lipid peroxidation status indicated that the antioxidative effect of the EPS contributes to alleviation of liver injury. Therefore, this study reports that the EPS produced by Pleurotus geesteranus could be considered a potential natural drug or functional food supplement for the prevention of liver damage.

The impact of donor liver allograft fibrosis on patients undergoing liver transplantation

BACKGROUND

The utilization of extended criteria liver allografts (ECD) shortens time to transplantation.

OBJECTIVE

To characterize the effect of liver allograft fibrosis on graft and patient survival after liver transplantation (LT), with particular attention to fibrosis progression.

METHODS

Retrospective database search of donor and recipient liver allograft histology of liver transplants performed between 2007 and 2011. Donor and patient characteristics were analyzed.

RESULTS

One hundred and one patients underwent LT with donor liver allografts with early-stage fibrosis (stage 1 fibrosis and stage 2 fibrosis). The level of liver fibrosis did not progress in 40% of the patients tested, and there was a regression of fibrosis in 30%. At a median follow-up of 71 months, of 101 patients transplanted with fibrotic livers, 63 patients (63%) were alive with functioning initial grafts, six patients (6%) were retransplanted, and 35 patients expired. The graft survival rates were 82% and 69% at 1 and 5 years, respectively. Graft survival differences were not found to be statistically significant between the degrees of liver allograft fibrosis: 5-year graft survival (73% for stage 1 fibrosis and 62% for stage 2 fibrosis, P = .24). The entire fibrosis group was further compared with a control group of 208 consecutive primary liver transplant patients with allografts having no fibrosis. The 5-year graft survival was not significantly different between the groups (69% for the fibrosis group vs 75% for the nonfibrosis group, P = .19). Survival was also not statistically different between the groups (5-year survival of 73% for the fibrosis group vs 79% for the nonfibrosis group, P = .2). In patients with HCV, graft survival differences were not found to be statistically significant with the use of early-stage fibrotic livers: 5-year graft survival of 60% for fibrosis group vs 70% for the nonfibrosis group, P = .22).

CONCLUSION

This study demonstrates that allografts with early-stage fibrosis achieve acceptable long-term survival after liver transplantation. Given these preliminary results, the use of organs with early-stage fibrosis warrants further studies at a larger scale to validate these results.