Liver Explant

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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.


  1. If you receive a Liver status post TA​RE (Trans-Arterial Radioembolization), please consult a PA and read procedure UCMC 1145 in MediaLab (Handling Radioactive Specimens in the Gross Pathology Laboratory).
  2. Weigh and measure in three dimensions.
  3. 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.
  4. Photograph a representative slice.
  5. 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.
  6. For fulminant necrosis and metabolic disorders: Take tissue for EM from several areas.  Also snap freeze tissue for diagnostic purposes.
  7. Fix in formalin if desired (i.e. Hepatitis C).  Otherwise, they can be cut fresh.


  1. 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).
  2. 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.
  3. 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.
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