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Frozen-section diagnosis in donor livers: error rate estimation of steatosis degree
E D'Alessandro1, F Calabrese, E Gringeri
1Department of Medical Diagnostic Sciences, Section of Special Pathology, University of Padua, Padua, Italy.
Abstract:
A high degree of macrovesicular steatosis is associated with a significant risk of graft dysfunction. Most centers, including ours, consider 60% the limit value for transplantability, while others have adopted 30% as a cutoff. Pretransplant frozen-section (PFS) evaluation is used for reliable quantification of steatosis. However, the accuracy of PFS analysis for the degree of steatosis has largely been debated due to its high grade of variability and subjectivity. The aim of our study was to evaluate the accuracy of PFS diagnosis compared with subsequent paraffin histology samples. We retrospectively analyzed PFS from 52 consecutive liver donors. All PFS were blindly reviewed by two pathologists. The results were graded according to two classifications: (A) lower or higher than 60% steatosis, or (B) mild (0%-30%), moderate (30%-60%), or severe (>60%) steatosis. The rate of error for A (two-grade classification score) was 1.9% with the erroneous discharge of a viable organ. The error rate for B (three-grade classification score) was 7.7% with four discrepancies. In three cases, the discrepancy was related to the mild to moderate cutoff value, leading to a clinical error rate of 5.8% (discharging organs with statosis >30%, when we used more strict criteria). Our study validated PFS analysis as a reliable technique when the maximum value for organ transplantation was 60% steatosis. There was a higher error rate when a cutoff value of 30% was used. This finding suggests the usefulness of another technique to support a more precise steatosis evaluation.
Insights
Pretransplant frozen-section (PFS) evaluation is reliable for assessing liver steatosis up to 60%. Higher error rates occur with stricter 30% cutoffs, suggesting a need for complementary techniques.
Area of Science:
- Hepatology
- Transplantation
- Pathology
Background:
- High macrovesicular steatosis increases liver graft dysfunction risk.
- Transplant centers use varying steatosis cutoffs (e.g., 60% or 30%) for organ eligibility.
- Pretransplant frozen-section (PFS) analysis is used for steatosis quantification but faces accuracy debates due to variability.
Purpose of the Study:
- To evaluate the diagnostic accuracy of PFS for liver steatosis compared to paraffin histology.
- To assess the impact of different steatosis grading classifications on transplant decisions.
Main Methods:
- Retrospective analysis of PFS from 52 liver donors.
- Blind review of PFS by two pathologists using two grading systems: A (≤60% vs. >60%) and B (mild, moderate, severe).
- Comparison of PFS results with paraffin histology.
Main Results:
- The two-grade classification (A) showed a 1.9% error rate, with one viable organ erroneously discharged.
- The three-grade classification (B) had a 7.7% error rate (four discrepancies).
- Clinical error rate was 5.8% when using a stricter 30% cutoff, involving misclassification of mild to moderate steatosis.
Conclusions:
- PFS analysis is a reliable method for steatosis evaluation when the transplant cutoff is 60%.
- A stricter 30% cutoff significantly increases the error rate, potentially impacting organ utilization.
- Further techniques may be beneficial for precise steatosis assessment, especially with lower thresholds.
