Postreperfusion biopsies are useful in predicting complications after liver transplantation

Biliary complications after orthotopic liver transplantation (OLT) may occu r because of preservation injury (PI), In this study, we examine findings o n routine reperfusion biopsy specimens in relation to the occurrence of bil iary complications and graft outcome. From 1997 to 2000, a total of 193 OLT s were performed in our center, Postreperfusion biopsy specimens were analy zed and histological lesions were graded. For analysis, grafts were grouped into 2 categories: the presence or absence of PI (severe to moderate lesio ns versus mild or no lesions), Histological evidence of PI was present in 1 7% of the biopsy specimens. The incidence of grafts with PI and ischemia ti me longer than 12 hours was 38% compared with 14% in PI and short ischemia time (P =,02), Biliary complications were also more frequent in the PI grou p (28% v 14%; P =,03), Study of risk factors by means of logistic regressio n analysis confirmed that the PI group had a greater risk for biliary compl ications (relative risk, 2.8; 95% confidence interval, 1 to 7.4; P =,03), M oreover, moderate macrovesicular steatosis was found in 6% of the grafts, r esulting in a 40% graft loss rate. We found that an increased presence of n eutrophilic infiltrates in the postreperfusion biopsy specimen, indicating PI, was related to an increased incidence of biliary complications. Moreove r, moderate macrovesicular steatosis was associated with increased graft lo ss. Therefore, postreperfusion biopsies are useful in anticipating post-OLT complications.