Hołówko W, Mazurkiewicz M, Grąt M, Koperski L, Lewandowski Z, Smoter P, Ziarkiewicz-Wróblewska B, Górnicka B, Zborowska H, Krawczyk M
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of Pathological Anatomy, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2014 Oct;46(8):2755-7. doi: 10.1016/j.transproceed.2014.09.102.
Because liver allograft steatosis is an important risk factor of graft dysfunction after liver transplantation, it must be taken into consideration during graft acceptance. The aim of this study was to evaluate the reliability of frozen section in the assessment of liver steatosis before transplantation.
The retrospective analysis was based on data of 112 liver allograft procurements performed between 2003 and 2012. Hepatic steatosis was assessed in frozen and routine sections. Sensitivity, specificity, and positive and negative predictive values of the frozen section were evaluated with respect to detection of >30% and >50% steatosis.
According to routine section assessment, there were 32 (28.6%) cases of steatosis >30% and 16 (14.3%) of >50%. The results of frozen section assessment were underestimated and overestimated in a similar low number of cases, both for the >30% (0.0% and 0.9%, respectively, P < 1.000) and the >50% (4.5% and 0.9%, respectively, P = .221) cutoff. Sensitivity, specificity, positive and negative predictive values of frozen section assessment were 100.0%, 98.8%, 97.0%, and 100.0%, respectively, for detection of >30% steatosis, and 68.8%, 99.0%, 91.7%, and 95.0%, respectively, for >50% steatosis.
Considering high positive predictive value of frozen section assessment in detection of >50% steatosis, it may serve as a base to discard the use of graft for transplantation. However, according to the relatively moderate sensitivity of this method, decision of graft acceptance must also be made on consideration of other well-known factors for poor posttransplant function.
由于肝移植术后移植肝脂肪变性是移植肝功能障碍的重要危险因素，因此在评估供肝时必须予以考虑。本研究的目的是评估冰冻切片在肝移植前评估肝脏脂肪变性的可靠性。
回顾性分析2003年至2012年间112例肝移植供肝的数据。对冰冻切片和常规切片进行肝脏脂肪变性评估。评估冰冻切片在检测脂肪变性>30%和>50%时的敏感性、特异性以及阳性和阴性预测值。
根据常规切片评估，脂肪变性>30%的病例有32例（28.6%），>50%的有16例（14.3%）。对于脂肪变性>30%（分别为0.0%和0.9%，P<1.000）和>50%（分别为4.5%和0.9%，P = 0.221）的截断值，冰冻切片评估结果在数量相近的病例中被低估和高估。对于检测脂肪变性>30%，冰冻切片评估的敏感性、特异性、阳性和阴性预测值分别为100.0%、98.8%、97.0%和100.0%；对于脂肪变性>50%，分别为68.8%、99.0%、91.7%和95.0%。
鉴于冰冻切片评估在检测脂肪变性>50%时具有较高的阳性预测值，它可作为弃用移植肝的依据。然而，由于该方法的敏感性相对中等，在决定是否接受供肝时还必须考虑其他导致移植后功能不良的已知因素。
