Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2021; 13(10): 1208-1214
Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1208
Non-invasive real-time assessment of hepatic macrovesicular steatosis in liver donors: Hypothesis, design and proof-of-concept study
Allwyn S Rajamani, Ashwin Rammohan, VV Raghavendra Sai, Mohamed Rela
Allwyn S Rajamani, VV Raghavendra Sai, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai 600036, India
Ashwin Rammohan, Mohamed Rela, Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai 600044, India
Author contributions: Rajamani AS and Rammohan A contributed to conception and design, acquisition, analysis and interpretation of data; Sai VR, Rammohan A and Rela M drafted the article, revised it critically for important intellectual content; Rela M gave the final approval of the version to be published.
Conflict-of-interest statement: The above doctors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashwin Rammohan, FACS, FRCS, Attending Doctor, Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, CLC Works Road Chromepet, Chennai 600044, India. ashwinrammohan@gmail.com
Received: March 7, 2021
Peer-review started: March 7, 2021
First decision: April 6, 2021
Revised: April 18, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 27, 2021
Abstract

Macrovesicular Steatosis (MS) is an independent risk factor for adverse post-liver transplant (LT) outcomes. The degree of MS is intimately related to the viability of the liver graft, which in turn is crucial to the success of the operation. An ideal liver graft should have no MS and most centres would find it unacceptable to use a donor liver with severe MS for LT. While a formal liver biopsy is the gold-standard diagnostic test for MS, given the logistical and time constraints it is not universally feasible. Other tests like a frozen section biopsy are plagued by issues of fallibility with reporting and sampling bias making them inferior to a liver biopsy. Hence, the development of an accurate, non-invasive, easy-to-use, handheld, real-time device for quantification of MS would fill this lacuna in the deceased donor selection process. We present the hypothesis, design and proof-of-concept of a study, which aims to standardise and determine the feasibility and accuracy of a novel handheld device applying the principle of diffuse reflectance spectroscopy for real-time quantification of MS.

Keywords: Macrovesicular steatosis, Deceased donors, Liver transplantation, Real-time devices, Diffuse reflectance spectroscopy

Core Tip: The degree of macrovesicular steatosis (MS) is intimately related to the viability of the liver graft, which in turn is crucial to the success of the liver transplant operation. The development of an accurate, non-invasive, easy-to-use, handheld, real-time device for quantification of MS would fill a lacuna in the deceased donor selection process. We present the hypothesis, design and proof-of-concept study for a novel handheld device for real-time quantification of MS.