PREDICTIVE VALUE OF INTRAOPERATIVE BIOPSIES AND LIVER-FUNCTION TESTS FOR PRESERVATION INJURY IN ORTHOTOPIC LIVER-TRANSPLANTATION

Eighty liver allografts were studied to determine the predictive value of intraoperative biopsies and postoperative liver function tests for the development of preservation injury (PI). Peak transaminase (aspar tate transaminase [AST] and alanine transaminase [ALT]) and prothrombi n time (PT) values achieved by each patient during postoperative days (POD) 1 through 7 were determined. PI in day 0 preperfusion biopsies ( 0Pre) (obtained immediately before implantation) and postperfusion bio psies (0Post) (obtained immediately after revascularization) was categ orized by histological criteria as present or absent. PI in biopsies t aken during POD 2 through 14 was histologically graded as either moder ate-to-severe, mild, or absent. Of the 80 allografts, 8 were omitted b ecause of primary nonfunction or postoperative complications. 0Pre and 0Post biopsies were available on 25 of 72 (35%) and 69 of 72 (96%) al lografts, respectively. Only 2 (8%) of the 0Pre biopsies showed histol ogical PI compared with 48 (70%) of the 0Post biopsies. Fifty-nine pat ients were biopsied between POD 2 through 14. Of these, 15, 28, and 16 patients developed moderate-to-severe, mild, or no evidence of PI, re spectively. The presence of PI in the 0Post biopsy strongly correlated with the development of PI during POD 2 through 14 (P <.0005). Peak A ST and ALT values in patients with moderate-to-severe PI on POD 2 thro ugh 14 were significantly elevated compared with those patients with e ither mild (P =.01 and .03) or no PI (P =.02 and .006). Because of ext ensive overlap in AST and ALT values between the three groups, however , transaminase values were not useful in predicting the presence or ab sence of PI in the individual case. The development of PI during POD 2 through 14 correlated with advanced donor age (P =.06) but was unasso ciated with 0Pre biopsy findings, cold ischemia time, or peak PT value s. We conclude that the 0Post biopsy is a valuable tool for the predic tion of subsequent PI in the early postoperative period. In contrast, 0Pre biopsy findings and peak AST and ALT values are not useful in the assessment of PI.