Non-invasive real-time assessment of hepatic macrovesicular steatosis in liver donors: Hypothesis, design and proof-of-concept study

Abstract

Macrovesicular Steatosis (MS) is an independent risk factor for adverse post-liver transplant (LT) outcomes. The degree of MS is intimately related to the viability of the liver graft, which in turn is crucial to the success of the operation. An ideal liver graft should have no MS and most centres would find it unacceptable to use a donor liver with severe MS for LT. While a formal liver biopsy is the gold-standard diagnostic test for MS, given the logistical and time constraints it is not universally feasible. Other tests like a frozen section biopsy are plagued by issues of fallibility with reporting and sampling bias making them inferior to a liver biopsy. Hence, the development of an accurate, non-invasive, easy-to-use, handheld, real-time device for quantification of MS would fill this lacuna in the deceased donor selection process. We present the hypothesis, design and proof-of-concept of a study, which aims to standardise and determine the feasibility and accuracy of a novel handheld device applying the principle of diffuse reflectance spectroscopy for real-time quantification of MS.

Risk factors and prediction of acute kidney injury after liver transplantation: Logistic regression and artificial neural network approaches

“…Liver specimens were evaluated by hematoxylin and eosin staining using either frozen or permanent section. Macrovesicular steatosis was defined as a single vacuole larger than the nucleus, replacing most of the hepatocyte cytoplasm and displacing the nucleus to the cell membrane[ 27 ]. Macrosteatosis was categorized as no steatosis (< 5%), mild steatosis (10%-29%), moderate steatosis (30%-60%), and severe steatosis (> 60%)[ 28 ].…”

Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

“…Surgical experience with macroscopic liver assessments therefore still plays an important role in supporting decision making, while machine perfusion (MP) techniques are explored to identify more reliable markers for viability assessments. New techniques to quantify the fat in the entire organ are currently being explored, including MRI and spectroscopy [ 78 , 79 ]. A large study with 20,000 transplants from the US and Europe demonstrated the safe use of microsteatotic grafts for recipients of all risk levels, according to the balance of risk (BAR) score [ 15 ].…”