Auto text: “Insert Liver Explant”
Native livers are removed at the time of transplantation and usually exhibit cirrhosis, massive necrosis or a metabolic disorder. Failed allografts may also be removed.
- If you receive a Liver status post TARE (Trans-Arterial Radioembolization), please consult a PA and read procedure UCMC 1145 in MediaLab (Handling Radioactive Specimens in the Gross Pathology Laboratory).
- Weigh and measure in three dimensions.
- For cirrhosis: Describe the approximate size of the surface nodules (micro vs. macro nodules) and uniformity or variability. Serially section into completely separate slices as thinly as possible (less than 1 cm). It is not necessary to preserve the configuration of the specimen by making only partial slices.
- Photograph a representative slice.
- Consult GI attending or fellow to determine if frozen tissue is necessary for diagnostics. If so, freeze a small section of normal and tumor, if present.
- For fulminant necrosis and metabolic disorders: Take tissue for EM from several areas. Also snap freeze tissue for diagnostic purposes.
- Fix in formalin if desired (i.e. Hepatitis C). Otherwise, they can be cut fresh.
- For cirrhosis:
- In the absence of discrete lesions, take three sections from the right lobe, three from the left lobe and 1 or 2 from the hilus to include the portal vein, hepatic artery and common bile duct.
- Order trichrome, reticulin, iron, PAS and PAD-D stains on one block. If Wilson Disease is suspected also order a Rhodanine (copper) stain.
- Take sections of all macroregenerative nodule(s) – recognized as usually larger, expansive nodules which look different than the surrounding regenerative nodules (seen especially in HCV, HBV, alcoholic cirrhosis and hemochromatosis).
- For livers removed for PSC, it is especially important to entirely embed the hilar soft tissue to exclude cholangiocarcinoma.
- In some cases, a metallic stent may be present connecting branches of the portal and hepatic veins (TIPS procedure). The ends of these stents can be ragged and sharp – Be Careful! Document the presence of the stent and its patency.
- If gallbladder is present, describe and submit representative sections (one cassette if age <50; two cassettes if age >=50).
- For fulminant necrosis and metabolic disorders:
- Estimate percentage of preserved or regenerating parenchyma (if possible).
- Take three sections each from the right and left lobes, plus a section from the hilum and a section of the galllbladder.
- Order trichrome, reticulin, iron, PAS and PAD-D stains on one block.
- For failed allografts:
- Take three sections each from the right and left lobes, plus two sections from the hilum.
- Order trichrome, reticulin and iron (no PAS) on one block.