Sense or Nonsense: Defining the Role of Routine Gallbladder Histopathology in Deceased Liver Transplantation

Abstract

Introduction: In liver transplantation donor cholecystectomy followed by histological assessment is routinely performed as part of the operation. However, the evidence on this topic is scarce. The aim of this study was to evaluate the impact of this standard of care treatment. Methods: A single centre retrospective analysis of all gallbladder histopathologies following liver transplantation between 01.01.2007 and 31.12.2016 was performed. Results: A total of 1012 histologies of donor gallbladders were included in this timespan. The median donor age was 47 years (range 1-79). In total 634 (63%) of the histologies were completely normal and did not show any abnormalities. 378 (37%) patients showed abnormal pathology results; 343 (33.9%) chronic cholecystitis. Of the 35 remaining gallbladders, 1 demonstrated high-grade dysplasia and one had a T1a gallbladder cancer and the rest were not significant pathologies. Those donors with normal histology had a median age of 45 years versus 50 years for abnormal histology (p < 0.05). Importantly, the recipient of the liver with T1a gallbladder cancer did not develop any signs of malignancy, although he required re-transplantation for unrelated reasons. Conclusion: Donor gallbladder histopathological analysis in liver transplantation has been the standard of care but the role of this routine procedure has never been identified. This is an important first analysis of a significant number of donor gallbladder specimens. Based on the abnormalities detected in this single centre experience we do think donor gallbladders should routinely be send for histopathology. Further high volume studies are needed to clearly answer this question.