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

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,https://links.lww.com/TP/B616, and SDC 2,https://links.lww.com/TP/B617). All 3 pathology reads were compared to one another. Steatosis, fibrosis, and inflammation were among analyzed data points (Figures S1-S5, SDC 3,https://links.lww.com/TP/B618). 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.

FIGURE 1: Microscope adapter with smartphone for transmission of telepathology images. Top (left to right): Side view of smartphone attached to microscope adapter and microscope; display of smartphone, adapter, and microscope setup; liver biopsy image demonstrating mild microvesicular and moderate macrovesicular steatosis, 20×. Bottom (left to right): liver biopsy images demonstrating minimal microvesicular and mild macrovesicular steatosis, 20× and 40×. Image quality graded as excellent in all images displayed.