Human donor liver viability evaluation with polarization-sensitive optical coherence tomography

Human liver transplantation is constrained by a critical shortage of viable donor livers. In response to this shortage, marginal livers from extended criteria donors are increasingly used to expand the donor pool. Donor liver viability assessment remains limited by invasive, biopsy-based pathological sampling, and there is a need for more comprehensive and noninvasive evaluation techniques to meet the increasing demand for liver transplants. In this study, we propose the use of polarization-sensitive optical coherence tomography (PS-OCT) to perform a multiparameter viability evaluation across the entire surface of donor livers. PS-OCT imaging was conducted on multiple regions of human donor livers, and the findings were cross-validated with histopathological evaluations. Machine learning and texture analysis were used to evaluate hepatic steatosis, fibrosis, inflammation, and necrosis from PS-OCT measurements in comparison with traditional pathological assessments, finding a correlation (>80%) between PS-OCT quantifications and pathology. PS-OCT imaging findings demonstrated strong correlations with donor liver functional performance during normothermic machine perfusion and with clinical liver transplant outcomes. PS-OCT offers a noninvasive assessment of liver viability by quantifying hepatic parameters across the entire donor liver, effectively complementing current pathological analysis. These results suggest that PS-OCT provides a robust approach to assessing donor liver viability, which could potentially decrease the discard rate of high-risk livers, thereby expanding the donor pool and reducing the inadvertent use of unsuitable livers for transplantation.