Introducing hyperspectral imaging as a novel tool for assessing donor liver quality during machine perfusion: A case report.

Abstract

Background: Hyperspectral imaging (HSI) offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs. Up to now, there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver. The allocated liver from a 49-year-old female donor (161 cm, 70 kg) was perfused with the OrganOx^® normothermic machine perfusion system in the recommended way. Organ quality assessment was performed based on laboratory values at defined time points. In addition, the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment. After discarding the organ, biopsies were taken from each segment and correlated with the results of the HSI.

Case summary: The donor liver's size (29 cm × 17 cm × 11 cm) and weight of 2180 g posed challenges for adequate placement within the organ container. Baseline biopsy of the liver revealed no evidence of fibrosis, steatosis or inflammation. An hour after perfusion start, measurements of the perfusate indicated a pH of 7.18, a glucose level of 404 mg/dL, and a lactate level of 1.7 mmol/L. Throughout perfusion, a significant decline in glucose levels began at the fourth hour, reaching a nadir of 20 mg/dL after eight hours. Concurrently, lactate levels steadily rose, peaking at 4.9 mmol/L after the total perfusion time of 12 hours. Macroscopic alterations (signs of congestion and reduced blood circulation) on the liver's surface were noted, particularly pronounced in segments 2, 3, and 8. HSI of these areas unveiled significant reduced oxygenation. Consequently, based on all these observations, the decision was made to discard the organ. Histological examination of the altered regions revealed congestion, necrotic changes, and dissociation of sinusoidal lining cells from liver cell cords. The histological findings correlated well with the HSI.

Conclusion: This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver. HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.