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The Use of Smartphone for Liver Graft Biopsy Assessment at the Time of Procurement

Bath, Natalie M., MD1; Wang, Xiaofei, MD2; Bledsoe, Jacob R., MD2; Thijssen, Maximiliaan, MD1; Ahearn, Aaron, MD, PhD1; Movahedi, Babak, MD, PhD1; Bozorgzadeh, Adel, MD1; Martins, Paulo N., MD, PhD1

doi: 10.1097/TP.0000000000002389
In Brief

1 Department of Surgery, Division of Transplant, University of Massachusetts, Worcester, MA.

2 Department of Pathology, University of Massachusetts, Worcester, MA.

Received 9 May 2018. Revision received 3 July 2018.

Accepted 10 July 2018.

This work was supported by a faculty career development grant in liver transplantation from AASLD and a career development grant from UMass awarded to Paulo N. Martins.

The authors declare no conflicts of interest.

N.M.B. participated in the performance of research, writing of the article and data analysis. X.W. participated in the performance of research and reading of pathology slides. J.B. participated in the performance of research, writing of the article, and reading of pathology slides. M.T. participated in the performance of the research and data analysis. A.A. participated in the research design and performance of research. B.M. participated in the research design and performance of research. A.B. participated in the research design and performance of the research. P.N.M. participated in the research design, writing of the article, and data analysis.

Correspondence: Paulo N. Martins, MD, PhD, Transplant Division, Department of Surgery, University of Massachusetts Memorial Medical Center, 55 Lake Ave North, Worcester, MA 01605. (

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Liver biopsy at procurement plays a crucial role in the acceptance of marginal grafts.1,2 Most organ procurements occur in hospitals that neither perform transplants nor have an experienced in-house pathologist after regular working hours. Conventional professional telepathology equipment could be used to circumvent this problem but are costly and often not widely available. By using a smartphone to acquire and transmit liver biopsies in real time to expert hepatopathologists, telepathology may potentially expedite and improve the assessment of liver graft quality. This report is the first to combine both telepathology and expert pathologist evaluation to liver transplantation.3 In this retrospective study, a resident physician utilized a smartphone with microscope adapter in order to capture magnified images and a short movie of 21 liver biopsies performed at procurement and transmitted these images to 2 experienced liver pathologists for independent and blind reads (Figure 1) (video S1-S2, SDC 1,, and SDC 2, All 3 pathology reads were compared to one another. Steatosis, fibrosis, and inflammation were among analyzed data points (Figures S1-S5, SDC 3, Our data did not find any statistically significant difference between local and remote slide evaluation in any category (P < 0.05). Importantly, there was no difference in the critical evaluation of steatosis. Telepathology via smartphone provides a reliable, simple, and inexpensive method to review instantly donor liver biopsies. The ability to transmit images from local hospitals to expert pathologists in real time has the potential for a more accurate assessment of organ quality and may help to optimize liver allocation. Future studies will apply these findings to a larger population.



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1. Lo IJ, Lefkowitch JH, Feirt N, et al. Utility of liver allograft biopsy obtained at procurement. Liver Transpl. 2008;14:639–646.
2. Yersiz H, Lee C, Kaldas FM, et al. Assessment of hepatic steatosis by transplant surgeon and expert pathologist: a prospective, double-blind evaluation of 201 donor livers. Liver Transpl. 2013;19:437–449.
3. Cesaretti M, Pote N, Dondero F, et al. Testing feasibility of an accurate microscopic assessment of macrovesicular steatosis in liver allograft biopsies by smartphone add-on lenses. Microsc Res Tech. 2018;81:58–63.

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