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Assessment of large droplet fat in frozen sections of donor liver biopsies: utility and interobserver variability of the newly described Banff method compared to a simplified Average of Fields method
  1. Alexander T Kikuchi1,2,
  2. Naoki Akanuma1,
  3. Won-Tak Choi1,
  4. Ryan M Gill1,
  5. Sanjay Kakar1
  1. 1 Pathology, University of California San Francisco, San Francisco, California, USA
  2. 2 Pathology, University of Utah Health, Salt Lake City, Utah, USA
  1. Correspondence to Dr Sanjay Kakar, University of California San Francisco, San Francisco, California, USA; sanjay.kakar{at}


Aims There is great variability in the assessment and reporting of fat in frozen sections of donor liver biopsies. The Banff Working Group has proposed a novel method and definition for scoring large droplet fat (LDF) in donor liver biopsies. This study compares the Banff method with a simpler Average of Fields (AF) method and evaluates the impact of different LDF definitions.

Methods Three pathologists assessed percentage of LDF (LDF%) in 10 donor liver biopsies using Banff and AF methods, applying the Banff LDF definition (cell distention with a single droplet larger than adjacent hepatocytes). Additionally, LDF% by the AF method was compared using two LDF definitions: Banff definition versus LDF definition 2 (single fat droplet occupying greater than half of a hepatocyte with nuclear displacement).

Results Intraobserver concordance between the Banff and AF methods was similar for all three pathologists (kappa 0.76–1). Both methods exhibited 70% interobserver concordance, and there was substantial agreement (kappa 0.68) in the LDF% among the three pathologists for both methods. Comparing the two LDF definitions, results were significantly lower with the Banff definition; LDF >50% was observed in four cases with LDF definition 2 but none of the cases with the Banff definition.

Conclusions There is high interobserver and intraobserver concordance of LDF% between the Banff and AF methods. LDF% determined by the Banff definition was lower than with LDF definition 2, and needs to be validated based on graft outcome before it can be recommended for clinical use.

  • transplantation
  • liver
  • liver diseases

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Yoh Zen.

  • Contributors ATK and NK contributed equally to this paper. SK is responsible for the overall content as guarantor. WTC, RMG, and SK performed the assessment of the specimen. ATK and NK collected the data and performed the analysis. ATK, NK, and SK wrote the original manuscript with review and editing by WTC and RMG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.