El-Mahrouk M, Langner C, Sucher R, Kniepeiss D. Introducing hyperspectral imaging as a novel tool for assessing donor liver quality during machine perfusion: A case report. World J Transplant 2025; 15(3): 102798 [DOI: 10.5500/wjt.v15.i3.102798]
Corresponding Author of This Article
Mohamed El-Mahrouk, Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz 8036, Steiermark, Austria. mohamed.el-mahrouk@medunigraz.at
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Transplant. Sep 18, 2025; 15(3): 102798 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102798
Introducing hyperspectral imaging as a novel tool for assessing donor liver quality during machine perfusion: A case report
Mohamed El-Mahrouk, Cord Langner, Robert Sucher, Daniela Kniepeiss
Mohamed El-Mahrouk, Robert Sucher, Daniela Kniepeiss, Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz 8036, Steiermark, Austria
Cord Langner, Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz 8036, Steiermark, Austria
Author contributions: El-Mahrouk M wrote the manuscript and analyzed case; Langner C contributed to histological image and interpretation; Sucher R contributed to hyperspectral imaging interpretation and improving manuscript; Kniepeiss D was the supervisor.
Informed consent statement: This case involves a liver from a deceased donor, so no signed consent for treatment form(s) or document(s) is required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed El-Mahrouk, Division of General, Visceral and Transplantation Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz 8036, Steiermark, Austria. mohamed.el-mahrouk@medunigraz.at
Received: November 7, 2024 Revised: February 2, 2025 Accepted: February 25, 2025 Published online: September 18, 2025 Processing time: 167 Days and 10.7 Hours
Abstract
BACKGROUND
Hyperspectral imaging (HSI) offers useful information on organ quality and has already been successfully used in kidney and liver transplantation to assess transplanted organs. Up to now, there is no case report in the literature describing HSI for quality assessment of a machine perfused donor liver. The allocated liver from a 49-year-old female donor (161 cm, 70 kg) was perfused with the OrganOx® normothermic machine perfusion system in the recommended way. Organ quality assessment was performed based on laboratory values at defined time points. In addition, the final evaluation of the liver comprised macroscopic findings and HSI of each liver segment. After discarding the organ, biopsies were taken from each segment and correlated with the results of the HSI.
CASE SUMMARY
The donor liver’s size (29 cm × 17 cm × 11 cm) and weight of 2180 g posed challenges for adequate placement within the organ container. Baseline biopsy of the liver revealed no evidence of fibrosis, steatosis or inflammation. An hour after perfusion start, measurements of the perfusate indicated a pH of 7.18, a glucose level of 404 mg/dL, and a lactate level of 1.7 mmol/L. Throughout perfusion, a significant decline in glucose levels began at the fourth hour, reaching a nadir of 20 mg/dL after eight hours. Concurrently, lactate levels steadily rose, peaking at 4.9 mmol/L after the total perfusion time of 12 hours. Macroscopic alterations (signs of congestion and reduced blood circulation) on the liver’s surface were noted, particularly pronounced in segments 2, 3, and 8. HSI of these areas unveiled significant reduced oxygenation. Consequently, based on all these observations, the decision was made to discard the organ. Histological examination of the altered regions revealed congestion, necrotic changes, and dissociation of sinusoidal lining cells from liver cell cords. The histological findings correlated well with the HSI.
CONCLUSION
This case report describes the integration of HSI in the decision making of the decline of a 49-year-old machine perfused donor liver. HSI offered useful information concerning the tissue morphology and graft viability and could therefore be a useful additional tool in assessing donor liver quality before transplantation.
Core Tip: This case report highlights the potential of hyperspectral imaging (HSI) as a valuable tool for assessing machine-perfused donor liver viability. By integrating HSI with laboratory and histological data, this method provides non-invasive insights into tissue oxygenation and morphology, aiding in organ quality evaluation and supporting decisions on transplantation suitability. This case underscores HSI’s potential as a valuable tool in pre-transplant liver evaluation.
