BACKGROUND: Intrahepatic bile duct strictures are a serious complication after non-heart-beating (NHB) liver transplantation. Bile salt toxicity has been identified as an important factor in the pathogenesis of bile duct injury and cholangiopathies. The role of bile salt toxicity in the development of biliary strictures after NHB liver transplantation is unclear. METHODS: In a porcine model of NHB liver transplantation, we studied the effect of different periods of warm ischemia in the donor on bile composition and subsequent bile duct injury after transplantation. After induction of cardiac arrest in the donor, liver procurement was delayed for 0 min (group A), 15 min (group B), or more or equal to 30 min (group C). Livers were subsequently transplanted after 4 hr of cold preservation. In the recipients, bile flow was measured, and bile samples were collected daily to determine the bile salt-to-phospholipid ratio. Severity of bile duct injury was semiquantified by using a histologic grading scale. RESULTS: Posttransplantation survival was directly related to the duration of warm ischemia in the donor. The bile salt-to-phospholipid ratio in bile produced early after transplantation was significantly higher in group C, compared with group A and B. Histopathologic condition showed the highest degree of bile duct injury in group C. CONCLUSION: Prolonged warm ischemia in NHB donors is associated with the formation of toxic bile after transplantation, with a high biliary bile salt-to-phospholipid ratio. These data suggest that bile salt toxicity contributes to the pathogenesis of bile duct injury after NHB liver transplantation.
BACKGROUND: Intrahepatic bile duct strictures are a serious complication after non-heart-beating (NHB) liver transplantation. Bile salttoxicity has been identified as an important factor in the pathogenesis of bile duct injury and cholangiopathies. The role of bile salttoxicity in the development of biliary strictures after NHB liver transplantation is unclear. METHODS: In a porcine model of NHB liver transplantation, we studied the effect of different periods of warm ischemia in the donor on bile composition and subsequent bile duct injury after transplantation. After induction of cardiac arrest in the donor, liver procurement was delayed for 0 min (group A), 15 min (group B), or more or equal to 30 min (group C). Livers were subsequently transplanted after 4 hr of cold preservation. In the recipients, bile flow was measured, and bile samples were collected daily to determine the bile salt-to-phospholipid ratio. Severity of bile duct injury was semiquantified by using a histologic grading scale. RESULTS: Posttransplantation survival was directly related to the duration of warm ischemia in the donor. The bile salt-to-phospholipid ratio in bile produced early after transplantation was significantly higher in group C, compared with group A and B. Histopathologic condition showed the highest degree of bile duct injury in group C. CONCLUSION: Prolonged warm ischemia in NHB donors is associated with the formation of toxic bile after transplantation, with a high biliary bile salt-to-phospholipid ratio. These data suggest that bile salttoxicity contributes to the pathogenesis of bile duct injury after NHB liver transplantation.
Authors: Michael E Sutton; Sanna op den Dries; Negin Karimian; Pepijn D Weeder; Marieke T de Boer; Janneke Wiersema-Buist; Annette S H Gouw; Henri G D Leuvenink; Ton Lisman; Robert J Porte Journal: PLoS One Date: 2014-11-04 Impact factor: 3.240
Authors: Rebecca A Sosa; Maura Rossetti; Bita V Naini; Victoria M Groysberg; Fady M Kaldas; Ronald W Busuttil; Yu-Ling Chang; David W Gjertson; Jerzy W Kupiec-Weglinski; Elaine F Reed Journal: Ann Surg Date: 2020-05 Impact factor: 13.787
Authors: Sanna Op den Dries; Michael E Sutton; Negin Karimian; Marieke T de Boer; Janneke Wiersema-Buist; Annette S H Gouw; Henri G D Leuvenink; Ton Lisman; Robert J Porte Journal: PLoS One Date: 2014-02-14 Impact factor: 3.240