Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany.
Diaspective Vision GmbH, Am Salzhaff, Germany.
Clin Transplant. 2022 Aug;36(8):e14736. doi: 10.1111/ctr.14736. Epub 2022 Jun 5.
In liver transplantation (LT), steatosis is commonly judged to be a risk factor for graft dysfunction, and quantitative assessment of hepatic steatosis remains crucial. Liver biopsy as the gold standard for evaluation of hepatic steatosis has certain drawbacks, that is, invasiveness, and intra- and inter-observer variability. A non-invasive, quantitative modality could replace liver biopsy and eliminate these disadvantages, but has not yet been evaluated in human LT.
We performed a pilot study to evaluate the feasibility and accuracy of hyperspectral imaging (HSI) in the assessment of hepatic steatosis of human liver allografts for transplantation. Thirteen deceased donor liver allografts were included in the study. The degree of steatosis was assessed by means of conventional liver biopsy as well as HSI, performed at the end of back-table preparation, during normothermic machine perfusion (NMP), and after reperfusion in the recipient.
Organ donors were 51 [30-83] years old, and 61.5% were male. Donor body mass index was 24.2 [16.5-38.0] kg/m . The tissue lipid index (TLI) generated by HSI at the end of back-table preparation correlated significantly with the histopathologically assessed degree of overall hepatic steatosis (R2 = .9085, P < .0001); this was based on a correlation of TLI and microvesicular steatosis (R2 = .8120; P < .0001). There is also a linear relationship between the histopathologically assessed degree of overall steatosis and TLI during NMP (R2 = .5646; P = .0031) as well as TLI after reperfusion (R2 = .6562; P = .0008).
HSI may safely be applied for accurate assessment of hepatic steatosis in human liver grafts. Certainly, TLI needs further assessment and validation in larger sample sizes.
在肝移植（LT）中，脂肪变性通常被认为是移植物功能障碍的危险因素，因此定量评估肝脂肪变性仍然至关重要。肝活检作为评估肝脂肪变性的金标准有一定的局限性，即侵袭性、观察者内和观察者间的变异性。一种非侵入性、定量的方法可以替代肝活检并消除这些缺点，但尚未在人类 LT 中得到评估。
我们进行了一项初步研究，以评估高光谱成像（HSI）在评估人类肝移植供体肝脏脂肪变性中的可行性和准确性。本研究纳入了 13 例已故供体肝移植。脂肪变性程度通过常规肝活检和 HSI 进行评估，HSI 在离体后准备、常温机器灌注（NMP）期间和受体再灌注时进行。
供体年龄为 51 [30-83] 岁，61.5%为男性。供体体重指数为 24.2 [16.5-38.0] kg/m。离体后准备结束时由 HSI 生成的组织脂质指数（TLI）与组织学评估的总体肝脂肪变性程度显著相关（R2=0.9085，P < 0.0001）；这是基于 TLI 与微泡性脂肪变性的相关性（R2=0.8120；P < 0.0001）。在 NMP 期间（R2=0.5646；P=0.0031）以及再灌注后（R2=0.6562；P=0.0008），组织学评估的总体脂肪变性程度与 TLI 之间也存在线性关系。
HSI 可安全应用于人类肝移植物肝脂肪变性的准确评估。当然，TLI 需要在更大的样本量中进一步评估和验证。
