Additional value of smartphone video recordings for the assessment of organ quality for livertransplantation
J.I. Erdmann, W.N. Nijboer, M.T. de Boer, W.G. Polak
Thursday 15 march 2018
16:45 - 16:55h
at Van Rijck/Ruys Zaal
Categories: Coördinatiesessie, Session (parallel)
Parallel session: Parallel session 10: Transplant coordination
Assessment of organ quality of a donor liver for transplantation remains a challenge. Currently assessment is based on a detailed history, additional radiologic imaging and laboratory results of the donor and eventually macroscopic evaluation of the organ. Although macroscopy is primarily evaluated by the donor surgeon, most surgeons are reluctant to start the recipient operation based on this evaluation. Due to logistics and travel distance this may prolong cold ischaemia end possibly the outcome of the transplantation. In the advent of modern smartphones it has become very easy to make and share high-quality images and video. In current practice this is not standardized, nevertheless it is increasingly being used. Aim of this study was to determine the pitfalls in the use of smartphone video recordings, and formulate a standard for the use of this emerging technology.
Methods
Surgeons and transplant coordinators from the three liver transplant centres in the Netherlands were asked to send videos used in the screening of donor organs. All videos were evaluated by an expert panel.
Results
A total of 41 smartphone video recordings were collected. Image quality was generally good (40/41). Most videos showed only segments 2 (n=29) 3 (n=40) 4 (n=37) and 5 (n=28), but were nonetheless always scored as sufficient. In 6 videos the liver was demonstrated on the backtable, showing all segments, and anatomy. Most videos were made after cold perfusion (25 vs 16). Consistency of the parenchyma and signs of chronic liver disease were reliably visible. In most cases color of the parenchyma and estimation of steatosis remained difficult. A clear difference was noted when the surgical lighthead was turned on or off and post- and pre-cold perfusion. Vascular anatomy was demonstrated in 9 cases, although only in two cases anatomic evaluation was complete. Evaluation by the expert panel, led to upfront rejection based on the video of 11 organs.
Conclusions
Smartphone video recordings are used clinically, but the number of segments shown and lighting is very variable. Backtable videos appear to be most informative. Structural changes, fibrosis, cirrhosis are generally adequately visible, even in short and limited videos. Most difficult remains the estimation of steatosis, most importantly caused by variable lighting conditions and non-calibrated cameras and screens. Development of a color standard may improve consistency and make interpretation more reliable.
