{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:58:26Z","timestamp":1790387906323,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007299","name":"Harvard Catalyst","doi-asserted-by":"publisher","award":["UM1TR004408"],"award-info":[{"award-number":["UM1TR004408"]}],"id":[{"id":"10.13039\/100007299","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Reliability of intraoperative assessment of donor liver allografts for steatosis, an important risk factor for future graft dysfunction, is limited by poor inter\u2010observer agreement. To address this issue, consensus guidelines by the Banff working group in 2022 proposed a standardized steatosis algorithm to improve agreement; however, the practical impact of the proposal has not been well\u2010validated across subspecialty practices and experience levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010institution inter\u2010observer agreement study entailed two rounds of evaluation of 27 frozen donor liver biopsies by 15 pathologists with a range of subspecialty expertise and experience levels. Raters estimated the amount of macrovesicular steatosis (MVS) by individual methods and, subsequently, using the proposed Banff algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Moderate agreement was observed among pooled raters, irrespective of method used (ICC 0.55 vs. 0.47 for individual and Banff methods, respectively) for precise estimation of MVS. Importantly, though, when precise estimates were reduced to clinically relevant grades, the Banff method improved agreement from \u2018fair\u2019 to \u2018substantial\u2019 compared with individual methods, with the most marked improvement among gastrointestinal subspecialists and pathologists with &gt; 10\u2009years of experience. The Banff method also resulted in overall lower grade estimates, with no \u2018grade 3\u2019 estimates provided, including from biopsies with abundant and azonal MVS, which are notoriously challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings support utilization of the Banff method as a means of improving inter\u2010rater agreement among diverse pathologists, resulting in more reliable estimation of MVS at clinically significant thresholds.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70283","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:58:46Z","timestamp":1790384326000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inter\u2010rater reliability of frozen donor liver macrovesicular steatosis assessment applying the Banff consensus method: a real\u2010world, multi\u2010specialty validation study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6810-2550","authenticated-orcid":false,"given":"Derek M","family":"Loneman","sequence":"first","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2008-1699","authenticated-orcid":false,"given":"Jarukit","family":"Tantipisit","sequence":"additional","affiliation":[{"name":"Department of Pathology Prince of Songkla University  Hat Yai Songkhla Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8622-0714","authenticated-orcid":false,"given":"Nicholas J","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0768-4764","authenticated-orcid":false,"given":"Ting","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0231-6583","authenticated-orcid":false,"given":"Maxwell","family":"Roth","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1067-0561","authenticated-orcid":false,"given":"Miranda","family":"Machacek","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Tsokos","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8097-2437","authenticated-orcid":false,"given":"Kyle M","family":"Devins","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0098-4682","authenticated-orcid":false,"given":"Haihui","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Pathology Mass General Brigham Salem Hospital  Salem Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8029-4787","authenticated-orcid":false,"given":"M Lisa","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2593-8268","authenticated-orcid":false,"given":"Michael G","family":"Drage","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1674-2557","authenticated-orcid":false,"given":"Stuti","family":"Shroff","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6826-0226","authenticated-orcid":false,"given":"Ivan","family":"Chebib","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Mattia","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0910-2655","authenticated-orcid":false,"given":"Jonathan N","family":"Glickman","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9092-2265","authenticated-orcid":false,"given":"Mari","family":"Mino\u2010Kenudson","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8945-5997","authenticated-orcid":false,"given":"Angela R","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Pathology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1097\/00007890-199312000-00025","article-title":"Frozen section evaluation of donor livers before transplantation","volume":"56","author":"Markin RS","year":"1993","journal-title":"Transplantation"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"270","DOI":"10.5858\/arpa.2011-0689-RA","article-title":"Approach to intraoperative consultation for donor liver biopsies","volume":"137","author":"Melin C","year":"2013","journal-title":"Arch. 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Hepatol."},{"key":"e_1_2_12_7_1","first-page":"1540","article-title":"Heterogeneity of hepatic steatosis definitions and reporting of donor liver frozen sections among pathologists: A multicenter survey","volume":"28","author":"Ho S","year":"2022","journal-title":"Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc."},{"key":"e_1_2_12_8_1","first-page":"1427","article-title":"High time for common ground in the assessment of steatosis","volume":"28","author":"Philosophe B","year":"2022","journal-title":"Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc."},{"key":"e_1_2_12_9_1","first-page":"191","article-title":"Assessment of liver transplant donor biopsies for steatosis using frozen section: Accuracy and possible impact on transplantation","volume":"3","author":"Heller B","year":"2011","journal-title":"J. Clin. Med. 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Clin. Pathol."},{"key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1111\/ajt.15877","article-title":"Perioperative and long\u2010term outcomes of utilizing donation after circulatory death liver grafts with macrosteatosis: A multicenter analysis","volume":"20","author":"Croome KP","year":"2020","journal-title":"Am. J. Transplant."},{"key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/PAS.0000000000000802","article-title":"Donor liver small droplet macrovesicular steatosis is associated with increased risk for recipient allograft rejection","volume":"41","author":"Choi WT","year":"2017","journal-title":"Am. J. Surg. 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Pathol."},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1097\/TP.0000000000003052","article-title":"Minimizing risks of\u00a0liver transplantation with Steatotic donor livers by preferred recipient matching","volume":"104","author":"Jackson KR","year":"2020","journal-title":"Transplantation"},{"key":"e_1_2_12_21_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0230995","article-title":"Higher thresholds for the utilization of steatotic allografts in liver transplantation: Analysis from a U.S. national database","volume":"15","author":"Steggerda JA","year":"2020","journal-title":"PLoS One"}],"container-title":["Histopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.70283","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/his.70283","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.70283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:58:55Z","timestamp":1790384335000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/his.70283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":20,"alternative-id":["10.1111\/his.70283"],"URL":"https:\/\/doi.org\/10.1111\/his.70283","archive":["Portico"],"relation":{},"ISSN":["0309-0167","1365-2559"],"issn-type":[{"value":"0309-0167","type":"print"},{"value":"1365-2559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"assertion":[{"value":"2026-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"his.70283"}}