Fluorescence Confocal Microscopy on Liver Specimens for Full Digitization of Transplant Pathology

September 2023 – Rapid evaluation of donor liver specimens for transplantation using the VivaScope® 2500 Technology

In this publication, the authors report for the first time on the application of a Confocal Microscope, here the VivaScope® 2500M-G4, as an alternative to frozen section for rapid evaluation of donor liver specimens.

M. N. Kinzler, et al. Liver Tranpl. 2023

Conventional histology remains the gold standard for the evaluation of specimens in liver transplant pathology, where the quality of donor livers is commonly investigated through frozen section procedure. However, the accessibility of frozen sectioning in a continuous 24/7 manner for transplant pathology departments is time-, cost- and labor-intensive. To overcome these challenges, together with the declined number of liver transplantations in Germany during recent years, it is necessary to develop alternative technologies to facilitate the evaluation of donor liver specimens.

The novel approach offers the following advantages:
  • No laboratory required
  • Easy and fast sample preparation and image acquisition (about 5 min), without assistance of a well-trained technician
  • Remote pathological evaluation with 24/7 availability, in real time
  • Overcoming difficulties of conventional handling for fragile/limited sample
  • Full preservation of specimen for subsequent immuno-histological or molecular analysis
  • Possibility to re-biopsy in case of sample inadequacy
  • Diagnostic power similar to frozen sectioning, but without sample damage or loss: almost perfect to substantial levels of agreement compared to frozen section for macrovesicular steatosis, steatohepatitis, inflammation, malignancy, fibrosis, necrosis and cholangitis

In this study, the innovative VivaScope® 2500 technology allowed rapid examination of 50 liver specimens including: FNB & CNB biopsies, surgical specimens, and donor liver samples. The resulting VivaScope® images were evaluated and compared to their corresponding paraffin- or frozen section H&E images, according to the liver transplantation criteria of the German Society for Organ Procurement (DSO). The agreement between VivaScope®- and frozen section images for DSO criteria was superior. Therefore, the authors suggested VivaScope® as an alternative to frozen section analysis.

This innovative technology can lead to faster therapeutic decisions in the management of liver transplants or generally for organ transplant medicine, especially in the diagnosis of pre-transplant donor biopsies.

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