Department of Cellular PathologyQueen Elizabeth Hospital BirminghamBirminghamUK.
Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK.
Hepatology. 2022 Apr;75(4):1014-1025. doi: 10.1002/hep.32208. Epub 2021 Dec 6.
No consensus criteria or approaches exist regarding assessment of steatosis in the setting of human donor liver suitability for transplantation. The Banff Working Group on Liver Allograft Pathology undertook a study to determine the consistency with which steatosis is assessed and reported in frozen sections of potential donor livers.
A panel of 59 pathologists from 16 countries completed a questionnaire covering criteria used to assess steatosis in donor liver biopsies, including droplet size and magnification used; subsequently, steatosis severity was assessed in 18 whole slide images of donor liver frozen sections (n = 59). Survey results (from 56/59) indicated a wide variation in definitions and approaches used to assess and report steatosis. Whole slide image assessment led to a broad range in the scores. Findings were discussed at a workshop held at the 15th Banff Conference on Allograft Pathology, September 2019. The aims of discussions were to (i) establish consensus criteria for defining "large droplet fat" (LDF) that predisposes to increased risk of initial poor graft function and (ii) develop an algorithmic approach to determine fat droplet size and the percentage of hepatocytes involved. LDF was defined as typically a single fat droplet that expands the involved hepatocyte and is larger than adjacent nonsteatotic hepatocytes. Estimating severity of steatosis involves (i) low magnification estimate of the approximate surface area of the biopsy occupied by fat, (ii) higher magnification determination of the percentage of hepatocytes within the fatty area with LDF, and (iii) final score calculation.
The proposed guidelines herein are intended to improve standardization in steatosis assessment of donor liver biopsies. The calculated percent LDF should be provided to the surgeon.
目前尚无共识标准或方法可用于评估人类供肝移植适应度时的脂肪变性情况。Banff 肝脏移植病理学工作组进行了一项研究，旨在确定在潜在供体肝脏冷冻切片中评估和报告脂肪变性的一致性。
来自 16 个国家的 59 位病理学家组成的专家组完成了一份问卷，涵盖了评估供体肝活检脂肪变性的标准，包括使用的液滴大小和放大倍数；随后，在 18 张供体肝脏冷冻切片全切片图像（n = 59）中评估了脂肪变性的严重程度。调查结果（来自 56/59）表明，用于评估和报告脂肪变性的定义和方法存在广泛差异。全切片图像评估导致评分范围广泛。在 2019 年 9 月举行的第 15 届 Banff 移植病理学会议上举行了一次研讨会，讨论了这些发现。讨论的目的是（i）建立定义“大液滴脂肪”（LDF）的共识标准，该标准易导致初始移植物功能不良的风险增加，（ii）制定一种算法方法来确定脂肪液滴大小和受影响的肝细胞百分比。LDF 被定义为通常使受影响的肝细胞膨胀且大于相邻非脂肪变性肝细胞的单个脂肪液滴。估计脂肪变性的严重程度涉及（i）低倍镜估计活检中脂肪占据的近似表面积，（ii）高倍镜确定脂肪区内具有 LDF 的肝细胞百分比，以及（iii）最终评分计算。
本文提出的指南旨在改善供体肝活检脂肪变性评估的标准化。应向外科医生提供计算出的 LDF 百分比。
