Perspective review on solid-organ transplant: Needs in point-of-care optical biomarkers

Solid-organ transplant is one of the most complex areas of modern medicine involving surgery. There are challenging opportunities in solid-organ transplant, specifically regarding the deficiencies in pathology workflow or gaps in pathology support, which may await alleviations or even de novo solutions, by means of point-of-care, or point-of-procedure optical biomarkers. Focusing the discussions of pathology workflow on donor liver assessment, we analyze the undermet need for intraoperative, real-time, and nondestructive assessment of the donor injuries (such as fibrosis, steatosis, and necrosis) that are the most significant predictors of post-transplant viability. We also identify an unmet need for real-time and nondestructive characterization of ischemia or irreversible injuries to the donor liver, earlier than appearing on morphological histology examined with light microscopy. Point-of-procedure laparoscopic optical biomarkers of liver injuries and tissue ischemia may also facilitate post-transplant management that is currently difficult for or devoid of pathological consultation due to lack of tools. The potential and pitfalls of point-of-procedure optical biomarkers for liver assessment are exemplified in breadth for steatosis. The more general and overarching challenges of point-of-procedure optical biomarkers for liver transplant pathology, including the shielding effect of the liver capsule that was quantitated only recently, are projected. The technological and presentational benchmarks that a candidate technology of point-of-procedure optical biomarkers for transplant pathology must demonstrate to motivate clinical translation are also foreseen.Electrical and Computer Engineerin

Effects of capsule on surface diffuse reflectance spectroscopy of the subcapsular parenchyma of a solid organ

We hypothesize that the capsular optical properties and thickness combined affect how accurate the diffuse reflectance on the surface of a capsular solid organ represents that on the subcapsular parenchyma. Monte Carlo simulations on two-layer geometries evaluated how a thin superficial layer with the thickness from 10 to 1000μm affected the surface diffuse reflectance over a source-detector separation spanning 0.01 to 10 mm. The simulations represented the superficial layer presenting various contrasts concerning refractive index, anisotropy factor, absorption coefficient, and reduced scattering coefficient, versus those of the subsurface main medium. An analytical approach modeled the effects of the superficial layer of various thicknesses and optical properties on diffuse reflectance. Diffuse reflectance spectroscopy was performed ex vivo on 10 fresh human livers and 9 fresh human kidneys using a surface probe with a 3-mm source-detector separation. The difference of the device-specific diffuse reflectance on the organ between with the capsule and without the capsule has significantly greater spectral variation in the kidney than in the liver. The significantly greater spectral deviation of surface diffuse reflectance between with and without the capsule in the kidney than in the liver was analytically accountable by considering the much thicker capsule of the kidney than of the liver.Electrical & Computer Engineerin

Biomarkers of rejection in kidney transplantation

PURPOSE OF REVIEW: To provide an update of the literature on the use of new biomarkers of rejection in kidney transplant recipients. RECENT FINDINGS: The kidney allograft biopsy is currently considered the gold standard for the diagnosis of rejection. However, the kidney biopsy is invasive and could be indeterminate. A significant progress has been made in discovery of new biomarkers of rejection, and some of them have been introduced recently for potential use in clinical practice including measurement of serum donor-derived cell free DNA, allo-specific CD154 + T-cytotoxic memory cells, and gene-expression \u27signatures\u27. The literature supports that these biomarkers provide fair and reliable diagnostic accuracy and may be helpful in clinical decision-making when the kidney biopsy is contraindicated or is inconclusive. SUMMARY: The new biomarkers provide a promising approach to detect acute rejections in a noninvasive way