tailieunhanh - Ebook Liver pathology - An atlas and concise guide: Part 2

(BQ) Part 2 book "Liver pathology - An atlas and concise guide" presentation of content: Transplant liver disorders, focal lesions and neoplastic diseases, pediatric liver diseases. | CHAPTER 4 TRANSPLANT LIVER DISORDERS Donor Liver Evaluation Preservation Injury Vascular and Biliary Tract Complications Acute Rejection Chronic Rejection Acute Hepatitis Recurrent Diseases Immune-Mediated Hepatitis and Other Findings in Late Posttransplant Biopsies Opportunistic Infections Posttransplant Lymphoproliferative Disorder Bone Marrow Transplantation Donor Liver Evaluation The donor liver is frequently subjected to frozen section analysis, prompted by clinical history of the donor, circumstances surrounding donor death, or macroscopic appearance of the organ such as a grossly fatty liver, which raises uncertainty on the suitability of the donor organ for transplantation. Liver Biopsy Size and Preparation A needle core from the anterior inferior edge of the liver is adequate in most cases, when the anticipated changes are diffuse. It is crucial that the biopsy is freshly obtained to reduce preservation artifacts, which result in underestimation or overestimation of the degree of steatosis or necrosis. In addition, biopsies kept in saline are significantly impacted by this medium, resulting in clumping of the cytoplasm and edema of the extracellular spaces. Routine hematoxylin & eosin–stained frozen section is adequate to determine the type and severity of steatosis and pathology in donor liver. Cadaveric Donor Liver Evaluation Although the criteria of a donor liver evolve over time, transplantation is currently contraindicated when infectious disease, sepsis, malignant tumor, or severe macrovesicular steatosis involving 60% or more of the parenchyma is detected. Other criteria considered include age of donor more than 60 years, extended cold ischemia (>12 hours), donation after cardiac death, extended intensive care unit stay, and history of malignancy. 126 Because recurrent hepatitis C virus (HCV) infection is universal after liver transplantation and its progression is .

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