Subcapsular hepatic necrosis in orthotopic liver allografts

Abstract

Five cases of subcapsular liver necrosis were found in a series of 55 hepatic orthotopic allografts examined at hepatectomy or autopsy during a 3-yr period at Children's Hospital of Pittsburgh. There was a pronounced rise in liver enzymes in the first few days in all of the cases after transplantation followed by a decrease in values in four of the cases over the next few days. All were characterized by an irregular subcapsular band of necrotic tissue involving both lobes, to a variable degree, but most frequently the right lobe. There were no obstructions or occlusions of the extrahepatic arteries, portal or hepatic veins. Hepatocyte necrosis was frequently observed in periportal areas, although centrilobular necrosis was also common. Varying degrees of steatosis were seen in the rest of the liver. Various etiological possibilities are discussed, particularly the role of hypoperfusion. Focal subcapsular necrosis of liver allografts may be more frequent than is presently realized. Awareness that hepatic necrosis in allografts may occur as localized subcapsular phenomenon may prevent misinterpretation of superficial biopsy findings as being representative of the entire organ, thus over-estimating the degree of damage.

Involvement of intrasinusoidal hemostasis in the development of concanavalin a-induced hepatic injury in mice

“…12 Moreover, the high incidence of necrotic foci in the subcapsular region, revealed in this study, is most likely derived from the hypoperfusion. 13 The analysis that uses a laser-doppler flowmeter showed a 20% to 50% decrease in the intrahepatic blood flow, which lasted several hours preceding the hepatic necrosis. Histological analysis showed that the sinusoidal lumen was occluded by agglutinated erythrocytes and by aggregated platelets and leukocytes and was also considerably expanded.…”

Significance of the computed tomography finding of subcapsular hepatic necrosis in liver transplantation

“…Indeed, multiple, small, peripheral subcapsular infarcts may be identified by frozen section in otherwise healthy grafts even prior to implantation. Russo and Yunis [7] described liver transplant infarction in pathological examination of grafts in five children; there was a question of injury during the procurement or implantation of each of these grafts. In addition, slow flow, particularly in the perioperative period, may predispose to necrosis in the peripheral or subcapsular regions of the transplant.…”

“…The CTHN / group had a statistical association with periportal collar, however the clinical significance is unclear, because periportal collar is a nonspecific CT finding. If periportal collar is indeed related to lymphatic obstruction, interruption of normal lymphatic drainage might be expected with mechanical distortion of the hepatic arteries, due to resection of restraining ligaments of the liver; this mechanism has been implicated as a cause of focal hepatic necrosis [7].…”

Pathology of Pediatric Gastrointestinal and Liver Disease

“…It can result in fulminant liver failure or ascites. 15.5d ) This is a pattern of hepatic infarction that has been noted in pediatric allografts, the exact etiology of which is not clear (Russo and Yunis 1986 ). (Fig.…”