Clinicopathological analysis of ischemia/reperfusion time-zero injury biopsies and its role in early allograft dysfunction in hepatic transplantation (retrospective cross-sectional study)

Abstract

Background and objectives Orthotropic liver transplantation is the only choice for treatment of end-stage liver diseases. B cell lymphoma 2 (BCL2) is a protein that regulates apoptosis. We aim to pinpoint the role of time-zero biopsies in predicting early graft dysfunction following liver transplantation by evaluation of BCL2 expression in hepatocyte. Patients and methods Thirty seven liver biopsies were evaluated histopathologically for ischemia–reperfusion injury and immunohistochemically by expression of BCL2. Results Out of 37 cases studied, 33 (89.2%) males and four (10.8%) females with a mean±SD age of 46.48 ± 12.05 years old. Their alanine aminotransferase average was 137.56 ± 76.46 U/l, the aspartate aminotransferase average was 62.84 ± 58.26 U/l, while international normalized ratio average was 1.79 ± 0.59. Histopathology shown, ballooning degeneration in 28 (75.7%), apoptosis was negative in 12 (32.4%), few in 13 (35.1%), and many in 12 (32.4%). Immunostaining with anti-BCL2 antibodies for apoptotic hepatocytes was negative in 12 (32.4%) and positive in 25 (67.6%). BCL2 expression was significantly higher with ballooning degeneration (P=0.019). BCL2 expression was significantly higher with apoptosis (P<0.001). Alanine aminotransferase, aspartate aminotransferase, and bilirubin levels were significantly higher with positive BCL2 expression (P=0.002, 0.025, and 0.002, respectively) and with positive ischemia/reperfusion injury (moderate or severe changes) (P=0.005, 0.032, and 0.008, respectively). Conclusion Liver pathology biopsy remains the ‘gold standard’ for the diagnosis of allograft dysfunction as when the clinical picture, liver enzymes, and imaging parameters are unclear.