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    Liver transplant


    Total hepatectomies at the time of liver transplant may be submitted for histology.1

    This protocol includes specimens from transplant hepatectomy surgery.

    Separate protocols are provided for intrahepatic tumours and hilar cholangiocarcinomas.

    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe
    • Yes
      • Special studies required, describe and ensure samples are taken prior to fixation.
    • Copper analysis
    • Iron analysis
    • Cytogenetics
    • Flow cytometry
    • Electron microscopy
    • Microbiology
    • Trials
    • Research
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.

    External Inspection

    Orientate and identify the anatomical features of the specimen:1

    • Hilar structures, gallbladder (if attached), falciform ligament, bare area on dome of right lobe
    • Any other tissue received (donor gallbladder, caudate lobe)

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:


    Record as stated by the clinician.

    Anatomical components included (more than one may apply) and dimensions (mm)

    Describe and measure the anatomical components present.

    • Liver, in three dimensions (antero-posterior x medio-lateral x supero-inferior)
    • Gallbladder, in three dimensions see gallbladder protocol
    • Donor gallbladder
    • Donor caudate lobe

    Specimen weight (g)

    • Record

    Liver capsule

    • Normal
    • Abnormal
      • Nodular
      • Breached by tumour
      • Evidence of previous biopsy, ablative intervention or surgery, e.g. scar or sutures.

    Hilar margins

    Describe the following for each of the three hilar structures (portal vein, common bile duct and hepatic artery should be separately identified):

    • Diameter (mm)
    • Patency
      • Patent
      • Occluded
    • Other findings, specify


    Slice perpendicularly to the parenchymal resection plane (preferably horizontally) at 5-10mm intervals.

    After sectioning the specimen may require longer fixation in larger quantity of formalin.

    Photograph the dissected specimen, specifically the slice(s) that best illustrate the diffuse disease process and any focal lesions.

    Internal Inspection

    Describe the cut surface appearance including the following items:


    • Brown
    • Yellow
    • Green
    • Nutmeg


    • Normal
    • Fibrotic
    • Cirrhotic

    Focal lesions2-5


    Dissect the specimen further and submit sections for processing according to the diagram provided.

    Submit at least one cross section at the resection margin of all three hilar structures:

    • Portal vein
    • Bile duct
    • Hepatic artery

    More sections may be submitted if appropriate. However, if after careful searching, none of the structures can be identified, submit a shave section of the hilar area.

    Submit representative sections from:

    • Each lobe (left, right and caudate)
    • Gallbladder, if present
    • Tumour-like lesions, if present (see intrahepatic protocol)

    Record details of each cassette.

    An illustrated block key similar to the one below may be useful.

    Block allocation key

    Cassette id
    No. of pieces
    Hilar vessels (hepatic vessels, portal vein and bile duct
    Left lobe
    Right lobe
    Caudate lobe
    Gallbladder, if applicable
    Tumour-like lesions, if applicable


    A/Prof Bastiaan de Boer for his contribution in reviewing and editing this protocol.


    1. Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
    2. Goodman ZD, Terracciano LM and Wee A. Tumours and tumour-like lesions of the liver. In: MacSween’s Pathology of the Liver, Burt AD, Portmann BC and Ferrell LD (eds), Churchill Livingstone Elsevier, 2012;761–852.
    3. Ishak KG, Goodman ZD and Stocker JT. Atlas of Tumour Pathology. Tumours of the Liver and Intrahepatic Bile Ducts. 3rd series, Fascicle 31. Armed Forces Institute of Pathology, Washington, 2001.
    4. Shah SA, Tan JC, McGilvray ID, Cattral MS, Cleary SP, Levy GA, Greig PD and Grant DR. Accuracy of staging as a predictor for recurrence after liver transplantation for hepatocellular carcinoma. Transplantation 2006;81(12):1633-1639.
    5. Plessier A, Codes L, Consigny Y, Sommacale D, Dondero F, Cortes A, et al. Underestimation of the influence of satellite nodules as a risk factor for post-transplantation recurrence in patients with small hepatocellular carcinoma. Liver transpl 2004;10(2 Suppl 1):S86-90.

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      Liver 15

      Hepatectomy, anterior surface

      Liver 16

      Liver transplant dissection

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