Perspective review on solid-organ transplant: needs in point-of-care optical biomarkers

• Published in: Journal of biomedical optics 2018-08, Vol.23 (8), p.080601-080601
• Main Authors: Piao, Daqing, Hawxby, Alan, Wright, Harlan, Rubin, Erin M
• Format: Article
• Language: English
• Subjects: Biomarkers - analysis; Fatty Liver - diagnostic imaging; Fatty Liver - pathology; Humans; Liver - chemistry; Liver - diagnostic imaging; Liver - pathology; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Liver Transplantation; Optical Imaging; Point-of-Care Systems; Transplants - chemistry; Transplants - diagnostic imaging; Transplants - pathology
• ISSN: 1083-3668; 1560-2281
• DOI: 10.1117/1.JBO.23.8.080601

Solid-organ transplant is one of the most complex areas of modern medicine involving surgery. There are challenging opportunities in solid-organ transplant, specifically regarding the deficiencies in pathology workflow or gaps in pathology support, which may await alleviations or even de novo solutions, by means of point-of-care, or point-of-procedure optical biomarkers. Focusing the discussions of pathology workflow on donor liver assessment, we analyze the undermet need for intraoperative, real-time, and nondestructive assessment of the donor injuries (such as fibrosis, steatosis, and necrosis) that are the most significant predictors of post-transplant viability. We also identify an unmet need for real-time and nondestructive characterization of ischemia or irreversible injuries to the donor liver, earlier than appearing on morphological histology examined with light microscopy. Point-of-procedure laparoscopic optical biomarkers of liver injuries and tissue ischemia may also facilitate post-transplant management that is currently difficult for or devoid of pathological consultation due to lack of tools. The potential and pitfalls of point-of-procedure optical biomarkers for liver assessment are exemplified in breadth for steatosis. The more general and overarching challenges of point-of-procedure optical biomarkers for liver transplant pathology, including the shielding effect of the liver capsule that was quantitated only recently, are projected. The technological and presentational benchmarks that a candidate technology of point-of-procedure optical biomarkers for transplant pathology must demonstrate to motivate clinical translation are also foreseen.