Feasibility of structured illumination fluorescence microscopy of liver biopsies for transplant evaluation (Conference Presentation)

Increased utilization of transplantation as treatment for patients with end-stage hepatic disease has resulted in a shortfall of available livers. Efforts to expand the available donor pool have resulted in the inclusion of donors who might not have been considered in the past. This has resulted in more requests for frozen section biopsy evaluation of the liver from "marginal" donors with significant co-morbidities. The information gained from the biopsy analysis determines whether the organ is suitable for transplantation. Critical to determining the adequacy of donor livers is analyzing the lipid content for macrosteatosis; high lipid livers are not suitable for transplant. Frozen section analysis (FSA) creates artifacts that limit tissue evaluation, exhausts tissue for downstream histological analysis, and requires a specialized team to evaluate these procedures in the hospital 24/7. We have developed a fluorescence microscopy system that utilizes structured illumination (SIM) to produce images of liver biopsies within seconds of removal from a deceased organ donor. Liver biopsies that require evaluation for donation suitability are stained with fast-acting fluorescent histology dyes and lipid specific stains in order to differentiate the lipids on SIM. The SIM images are compared to the standard-of-care FSA and the final pathology report. Here, we present the results of this blinded review performed by a liver pathology specialist. Imaging liver biopsies with SIM provides a more direct and accurate tool for determining macrosteatosis compared to standard FSA. SIM offers minimal tissue processing complexity and remote viewing capabilities, creating the potential to revolutionize tissue donation evaluation.