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Updated: Jan 13, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
The Role of Liver Biopsy Findings in Uncontrolled Donation After Circulatory Death a 4-Year Single-Center Experience
Luca Novelli1, Chiara Lazzeri2, Davide Ghinolfi3
1Institute of Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy.
Insights
Liver biopsies in uncontrolled donors after circulatory death (uDCDs) reveal common steatosis and mild inflammation, offering insights into donor health and potential ischemic-reperfusion injury. These findings aid in assessing donor liver suitability for transplantation.
Area of Science:
- Transplantation immunology
- Organ procurement
- Hepatology
Background:
- Uncontrolled donors after circulatory death (uDCDs) represent a significant, yet underutilized, donor pool.
- Limited data exists on the histopathological characteristics of livers from uDCDs.
- This study addresses the gap by examining liver biopsy findings in uDCDs.
Purpose of the Study:
- To evaluate the histopathological features of liver biopsies obtained from uncontrolled donors after circulatory death (uDCDs).
- To determine the prevalence of steatosis, inflammation, and ischemic-reperfusion injury in uDCD livers.
- To assess the potential of liver biopsy to inform donor liver suitability and understand donor-related factors.
Main Methods:
- A consecutive series of 29 utilized uncontrolled donors after circulatory death (uDCDs) admitted between 2019 and 2023 were included.
- Liver biopsies were performed during the organ procurement procedure for all included donors.
- Standard histopathological assessment including Ishak grading and evaluation for steatosis and injury was conducted.
Main Results:
- The median time from cardiac arrest to normothermic regional perfusion (NRP) was 144 minutes, with a median NRP duration of 6 hours.
- Livers were retrieved but not transplanted in 41% (12/29) and transplanted in 35% (10/29) of cases; 24% (7/29) were not retrieved.
- The majority of biopsies showed mild steatosis (microsteatosis <50% in 82%, macrosteatosis <30% in 76%) and mild inflammation (Ishak grade 1-2 in 72%), with severe ischemic-reperfusion injury (IRI) noted in 16% (4/24).
Conclusions:
- Liver biopsies in uDCDs provide crucial information regarding chronic damage (steatosis, Ishak score) and acute injury (ischemic-reperfusion injury).
- These histopathological findings can assist clinicians in evaluating the suitability of uDCD livers for transplantation.
- The biopsy data may also offer insights into the impact of the uDCD process and donor comorbidities on liver quality.
Background:
Uncontrolled donors after circulatory death (uDCDs) are recognized as a potential donor pool. No data are so far available on liver biopsy findings in uDCDs. We aimed at assessing liver biopsy findings in uDCDs consecutively admitted to our Center from 2019 to 2023.
Methods:
Twenty nine utilized uDCD consecutively admitted at our Center from 2019 to 2023 were included. Liver biopsies were performed during organ procurement in all uDCDs.
Results:
The median time from cardiac arrest to normothermic regional perfusion (NRP) run was 144 min, while the median NRP duration was 6 h. The liver was retrieved but not transplanted in 12 donors (12/29, 41%) and transplanted in 10 donors (10/29, 35%). In 7 uDCDs, livers were not retrieved (24%). Ishak grading score 1-2 was observed in most biopsies (21/29, 72%). The incidence of microsteatosis <50% and macrosteatosis <30% was prevalent in our series (24/29, 82% and 22/29, 76%). Lobular infiltration was found in most biopsies (15/24, 63%), while hepatocellular focal necrosis was documented in the 45% (11/24). Severe IRI was found in a small percentage of uDCDs (4/24, 16%).
Conclusion:
In our series, liver biopsy in uDCDs may provide clinicians with two different kinds of information. The first one may be mainly related to comorbidities and chronic damages, as indicated by the presence (and percentages) of micro/macrosteatosis and Ishak grading/score. The second one might provide insights into the ischemic-reperfusion injury of the liver, that is it might be related to the uDCD process itself.
