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It also addresses specimen adequacy (fresh submission and portal tract counts), grading of hepatitis, and fibrosis staging using Ishak criteria to assess transplant outcomes and reduce avoidable organ discard.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/recommended-histopathologic-features-to-evaluate-on-liver-core-biopsies-for-donor-liver-transplantation/459499/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/recommended-histopathologic-features-to-evaluate-on-liver-core-biopsies-for-donor-liver-transplantation/459499.png","ImageObject",300,407,{"name":42,"@type":43},"\tJames","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Why is histopathologic evaluation of donor liver core biopsies important before transplantation?","Question",{"text":62,"@type":63},"It provides critical information on organ quality, suitability of the candidate, likely transplant outcomes, and survivability, and helps prevent unnecessary organ discard when the liver may still be suitable.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How is steatosis subdivided and defined in the article?",{"text":67,"@type":63},"Steatosis is divided into macrovesicular (macrovesicular steatosis) and microvesicular categories, with Banff consensus definitions used for large-droplet macrovesicular (LDMS), small-droplet macrovesicular (SDMS), and microvesicular steatosis, emphasizing differing droplet appearance and nuclear displacement.",{"name":69,"@type":60,"acceptedAnswer":70},"What specimen and staging criteria does the article highlight for fibrosis and hepatitis?",{"text":71,"@type":63},"It notes common adequacy standards for core biopsy (at least six portal tracts) and describes hepatitis grading (none to severe) based on periportal lymphocytes and septal extension, while fibrosis is staged using Ishak staging categories including incomplete and complete cirrhosis.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},459499,1790756052,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & 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[https://doi.org/10.4285/ctr.25.0020](https://doi.org/10.4285/ctr.25.0020)  \nReceived March 24, 2025  \nRevised May 8, 2025  \nAccepted July 30, 2025  \nCorresponding author: Payam S. Pahlavan Department of Pathology, Lutheran Hospital, 7950 W Jefferson Blvd, Fort Wayne, IN 46804, USA  \nE-mail: [payamsp@yahoo.com](payamsp@yahoo.com)  \n© The Korean Society for Transplantation This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)) [which](which) permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.  \npISSN 3022-6783 eISSN 3022-7712  \nRecommended histopathologic features to evaluate on liver core biopsies for donor liver transplantation  \nPayam S. Pahlavan  \nDepartment of Pathology, Lutheran Hospital, Fort Wayne, IN, USA  \nOrthotopic liver transplantation is widely regarded as the treatment of choice for patients with end-stage liver disease. Routinely, following the confirmation of death in potential donors, the transplant surgeon submits a core liver biopsy to the pathologist as a frozen section sample for evaluation of the histopathologic criteria relevant to transplantation. This practice has become increasingly common as there is a continuous need to expand the donor pool, for example, by including older donors or those with viral hepatitis. The use of extended criteria is now generally accepted as a means to increase the availability of donor organs. Histopathological evaluation of a core liver biopsy prior to transplantation provides critical information regarding organ quality, suitability of the candidate, transplant outcomes, and survivability, as well as preventing unnecessary organ discard when the liver may actually be suitable for transplantation [1] . This approach can significantly benefit patients on the waiting list by increasing the number of available donor organs [2] . However, some centers do not routinely perform this evaluation due to various factors, including younger donor age (under 30 years), low body mass index (lean individuals), lack of risk factors for liver disease, absence of family consent, time constraints, or the unavailability of technicians and pathologists [3] .  \nFrom a demographic perspective, there is no strict age limitation for the allograft [4] . The core biopsy should be submitted fresh and as soon as possible after sampling to the frozen section, in order to avoid drying artifacts (such as hole artifacts), which may negatively impact the assessment of steatosis. There is no universally accepted guideline for the adequacy of a core biopsy, but a commonly accepted standard is that the core should display  \nat least six portal tracts. The initial step in evaluating the biopsy is to search for any potential malignant lesion that would render the specimen unsuitable for transplantation [5] . The next key parameter to evaluate is steatosis, which is subdivided into macrovesicular and microvesicular steatosis. Understanding the correct definitions and subclassifications of steatosis is essential. According to the Banff consensus recommendations for steatosis assessment [6,7], the following definitions are used: (1) large-droplet macrovesicular steatosis (LDMS) is defined as a single fat droplet distending the hepatocyte and displacing the nucleus to the cell periphery. (2) Small-droplet macrovesicular steatosis (SDMS) refers to fat droplets that do not meet the criteria for LDMS or microvesicularsteatosis; these are typically small, variably sized droplets occupying the cytoplasm with the nucleus remaining centrally located. (3) Microvesicular steatosis consists of diffuse, small droplets within hepatocytes, usually less than 2 μm², producing a foamy appearance wit","cbCaieU7zaqNNtOv","https://ap.wps.com/l/cbCaieU7zaqNNtOv","pdf",134107,"English","# Recommended histopathologic evaluation\n## Specimen handling and adequacy\n## Screening for malignant lesions\n## Steatosis definitions and Banff terminology\n## Hepatitis grading and Ishak-based fibrosis staging","[{\"question\":\"Why is histopathologic evaluation of donor liver core biopsies important before transplantation?\",\"answer\":\"It provides critical information on organ quality, suitability of the candidate, likely transplant outcomes, and survivability, and helps prevent unnecessary organ discard when the liver may still be suitable.\"},{\"question\":\"How is steatosis subdivided and defined in the article?\",\"answer\":\"Steatosis is divided into macrovesicular (macrovesicular steatosis) and microvesicular categories, with Banff consensus definitions used for large-droplet macrovesicular (LDMS), small-droplet macrovesicular (SDMS), and microvesicular steatosis, emphasizing differing droplet appearance and nuclear displacement.\"},{\"question\":\"What specimen and staging criteria does the article highlight for fibrosis and hepatitis?\",\"answer\":\"It notes common adequacy standards for core biopsy (at least six portal tracts) and describes hepatitis grading (none to severe) based on periportal lymphocytes and septal extension, while fibrosis is staged using Ishak staging categories including incomplete and complete cirrhosis.\"}]","Recommended histopathologic features to evaluate on liver core biopsies for donor liver transplantation | PDF"]