{
    "abstract": "There is a shortage of livers for transplantation in the United Kingdom; despite this, more than a fifth of those retrieved are not transplanted. Normothermic machine perfusion (NMP) allows a functional assessment of marginal\u00a0organs using biochemical parameters. This study describes the histological changes in livers undergoing NMP.\nA total of 170 biopsies taken pre-NMP, after 4\u2009h of NMP, end-NMP and at implantation from 50 livers undergoing NMP as part of standard local transplant practice were retrospectively reviewed. Thirty-eight per cent had large droplet macrovesicular steatosis pre-NMP, which was associated with reduced organ utilisation, P\u2009=\u20090.096, subsequent extracellular fat and a neutrophilic reaction; 32% had small droplet macrovesicular steatosis pre-NMP suggestive of acute cellular stress, the severity of which was unchanged in 64% during the perfusion period. Those showing at least moderate hepatocellular necrosis at end-NMP were less likely to be transplanted (55 versus 24%, P\u2009=\u20090.0505). Variation in the extent of hepatocyte necrosis was seen between biopsies, with 43% of transplanted cases showing less hepatocyte necrosis at implantation compared to end-NMP and 21% more severe necrosis. Patchy portal inflammation was present in 96% of pre-NMP biopsies, although identifiable duct injury was rare and portal thrombi were not identified. Sinusoidal dilation pre-NMP was more frequent in donation after circulatory death donors, typically persisted during NMP although had improved by implantation in most and had resolved in cases with an early post-transplant biopsy.\nHistological changes in NMP livers predominantly comprise donor-derived steatosis, stress-associated small droplet steatosis, retrieval- and procedure-associated sinusoidal dilation and ischaemic injury.",
    "authors": [
        {
            "affiliation": "Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.",
            "firstname": "A L",
            "initials": "AL",
            "lastname": "Paterson"
        },
        {
            "affiliation": "The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.",
            "firstname": "R",
            "initials": "R",
            "lastname": "Gaurav"
        },
        {
            "affiliation": "The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.",
            "firstname": "L",
            "initials": "L",
            "lastname": "Swift"
        },
        {
            "affiliation": "The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.",
            "firstname": "R",
            "initials": "R",
            "lastname": "Webster"
        },
        {
            "affiliation": "The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.",
            "firstname": "C",
            "initials": "C",
            "lastname": "Fear"
        },
        {
            "affiliation": "The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.\nThe University of Cambridge Department of Surgery, Cambridge, UK.",
            "firstname": "A J",
            "initials": "AJ",
            "lastname": "Butler"
        },
        {
            "affiliation": "The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.\nThe University of Cambridge Department of Surgery, Cambridge, UK.",
            "firstname": "C J E",
            "initials": "CJE",
            "lastname": "Watson"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024 John Wiley & Sons Ltd.",
    "doi": "10.1111/his.15371",
    "journal": "Histopathology",
    "keywords": [
        "histology",
        "liver transplantation",
        "normothermic perfusion",
        "organ preservation"
    ],
    "methods": null,
    "publication_date": "2024-11-20",
    "pubmed_id": "39564610",
    "results": null,
    "title": "Evolution of morphological changes in donor livers undergoing normothermic machine perfusion.",
    "xml": "<Element 'PubmedArticle' at 0x78850319e1b0>"
}