Intrahepatic arteriopathy associated with primary nonfunction of liver allografts

In this report we describe two cases of liver allograft primary non-function in which the donor organs were obtained from patients with a long-standing history of hypertension and placed in normotensive 2recipients. Examination of these failed grafts showed marked luminal narrowing of the medium and large intrahepatic arteries along with extensive hepatocellular necrosis. No evidence of cellular allograft rejection was present. Preoperative frozen section evaluation of the donor liver failed to detect any pathological changes in the donor organs. Morphometric studies showed a statistically significant luminal narrowing of the medium arteries in these patients compared with controls with graft failure because of other causes (P < .0001). To our knowledge there are no previous reports describing this finding in the literature. We hypothesize that the arterial narrowing in these livers resulted in compromised blood flow to the organ after transplantation into a normotensive patient. Further studies are necessary to determine the frequency of these changes in the hypertensive population. Such studies may lead to the development of criteria that will identify potential donors who are likely to have such changes before organ procurement.