الفهرس 
The role of liver biopsies following graft reperfusion in prediction of recipient outcome in living donor liver transplantation
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Abstract
Introduction: LT is the only curative treatment option for patients with irreversible acute or chronic liver failure. The aim of the study: to highlight the role of post reperfusion biopsies in predicting the outcome of recipients in LDLT. Patients & Methods: The present study was done on 49 patients who underwent LDLT in El-Manial Specialized Hospital and NHTMRI. All patients were submitted to full history, full examination, full pre-transplantation labs and imaging. Subcapsular wedge biopsy specimens of liver allografts were taken intraoperatively after complete revascularization of the allograft, and then reviewed by two pathologists for abnormal histopathological findings including: Hepatocyte ballooning degeneration, steatosis, cholestasis, neu»trophilic infiltration and hepatoyte necrosis. The severity of the IRI was graded upon the presence of neutrophilic infiltrate and hepatocyte necrosis and then analysis was performed to identify associations between the severity of IRI on the time-zero biopsy and a series of donor, recipient and intraoperative factors. The correlation of the severity of histologically determined IRI with patient and ICU stay, patient survival and graft outcomes (Perioperative and early post operative) was evaluated. Results: In our study, we found that prolonged cold ischemia time and prolonged warm ischemia time were independent predictors of a greater severity of IRI on the time-zero biopsy. Also, Positive IRI group showed a significant rise in Total, direct bilirubin, ALT, AST and INR on postoperative days 5,7and after one month of transplantation. About 50% of the severe IRI group met the biochemical and hematological criteria within the first 7 days for EGD which was statistically significant. Surprisingly, donor biopsy steatosis was not associated with the severity of IRI. Conclusion: Time zero biopsy is beneficial in predicting graft outcome in LDLT so it should be obtained routinely in LDLT programs. It is possible to identify those patients with more severe IRI early on intraoperative biopsy, and this raises the possibility that those patients identified may receive the most benefit from therapies specifically aimed at ameliorating the consequences of IRI