Predictive value of computerized morphometric analysis of steatosis in donor livers

Aims To describe, by computerized morphometry, the degree and the type of steatosis in liver transplants that developed primary non-function and to compare the results with the quantification by pathologist. Materials and Methods Twelve patients who developed primary non-function after liver transplantation were matched with 23 transplanted patients with a regular postoperative clinical course. Morphology of the liver biopsy included many stereological parameters; all cases were evaluated by a blinded operator blinded to the diagnosis and to the clinical history. The assessment of steatosis by morphometry was compared with pathologist’s evaluation. Moreover, to assess the reproducibility of the morphometric model, another operator applied the morphometric model in a blinded fashion to a randomly selected sample of cases. Results The percentage of hepatocytes with microsteatosis and the ratio macro/microsteatosis were higher in primary non-function. Pathologist’s evaluation of steatosis showed a marked overestimation when compared to morphometry. Lastly, the comparison between the results of two blinded operators of morphometric analysis showed a high reproducibility with a low inter-observer variability . Conclusions Our quantitative estimation of the degree and the quality of steatosis avoids inter-observer interpretations. Moreover, our analysis shows that the quantification of steatosis in liver transplantation by the current assessment must be reviewed in order to re-evaluate the real impact of steatosis.