Garcia Ureña M A, Colina Ruiz-Delgado F, Moreno González E, Jiménez Romero C, García García I, Loinzaz Segurola C, Gómez Sanz R
Department of Surgery and Abdominal Organs Transplantation, University Hospital, Madrid, Spain.
World J Surg. 1998 Aug;22(8):837-44. doi: 10.1007/s002689900479.
Fatty change in donor livers is a risk factor for poor function after orthotopic liver transplantation. Various prevalences of steatosis have been reported in time 0 biopsies. The aim of this research was to determine, in a longitudinal study, the degree (percent of hepatocytes involved) and type (size of vacuoles) of fatty change shown by various histologic techniques. Four staining methods were used on sections from three liver wedge biopsies--at liver procurement, at the back-table, and after reperfusion--from 83 consecutive donor livers. Results in Sudan III-stained (SS) sections showed the greatest sensitivity (87.1%), negative predictive value (91.8%), and agreement rate (k = 0.77) when compared with results in thin (1 micron) plastic-embedded toluidine blue-stained (TBS) sections. High-grade steatosis (> 30% steatotic hepatocytes) was identified in 49.4% of SS sections, 46.9% of TBS sections, 38.5% of frozen hematoxylin-eosin (H&E)-stained sections, and 20.7% of deparaffinated H&E-stained sections. Microscopic observations disclosed two types of steatotic pattern: (1) A predominantly small-droplet lipid vacuolzation (high-grade microsteatosis), similar to the steatosis associated with Reye syndrome, was seen in 29% of SS sections and 25% of TBS sections--approximately one-fourth of grafts; and (2) a combined pattern of large and small fat drops (high-grade macromicrosteatosis) was seen in 20% of SS sections and 22% of TBS sections. We concluded that moderate to severe steatosis is a frequent finding in donor livers. The difficulty in detecting lipidic microvacuoles in H&E-stained sections may be the reason for underestimating the grade of fatty change or even for diagnosing as normal some biopsies with high-grade microsteatosis.
供体肝脏中的脂肪变性是原位肝移植后肝功能不良的一个危险因素。在0时活检中已报道了不同的脂肪变性患病率。本研究的目的是在一项纵向研究中，确定各种组织学技术所显示的脂肪变性程度（受累肝细胞百分比）和类型（空泡大小）。对83例连续供体肝脏在肝获取时、手术台上和再灌注后的三个肝楔形活检切片使用了四种染色方法。与薄（1微米）塑料包埋甲苯胺蓝染色（TBS）切片的结果相比，苏丹III染色（SS）切片的结果显示出最高的敏感性（87.1%）、阴性预测值（91.8%）和符合率（k = 0.77）。在49.4%的SS切片、46.9%的TBS切片、38.5%的冷冻苏木精-伊红（H&E）染色切片和20.7%的脱蜡H&E染色切片中发现了高级别脂肪变性（> 30%脂肪变性肝细胞）。显微镜观察发现了两种脂肪变性模式：（1）主要为小滴状脂质空泡化（高级别微脂肪变性），类似于与瑞氏综合征相关的脂肪变性，在29%的SS切片和25%的TBS切片中可见——约四分之一的移植物；（2）大小脂肪滴组合模式（高级别大微脂肪变性）在20%的SS切片和22%的TBS切片中可见。我们得出结论，中度至重度脂肪变性在供体肝脏中很常见。在H&E染色切片中检测脂质微空泡的困难可能是低估脂肪变性程度甚至将一些具有高级别微脂肪变性的活检诊断为正常的原因。
