Altered bile composition after liver transplantation is associated with the development of nonanastomotic biliary strictures

Buis, Carlijn I.; Geuken, E; Visser, Dorien S.; Kuipers, Folkert; Haagsma, Elizabeth B.; Verkade, Henkjan J.; Porte, Robert J.

doi:10.1016/j.jhep.2008.07.032

Cited by 91 publications

(61 citation statements)

References 54 publications

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“…ITBL are a serious complication that generally occurs at 1-12 months after liver transplantation and can affect up to 25% of patients (1,8,9,13,14). Patients developing ITBL have a significantly worse graft and overall survival and ITBL has become a leading cause of liver retransplantation (8,13).…”

Section: Discussionmentioning

confidence: 99%

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The Importance of Portal Venous Blood Flow in Ischemic-Type Biliary Lesions after Liver Transplantation

Farid

Jonge

Slieker

et al. 2011

American Journal of Transplantation

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Ischemic-type biliary lesions (ITBL) are the most frequent cause of nonanastomotic biliary strictures after liver transplantation. This complication develops in up to 25% of patients, with a 50% retransplantation rate in affected patients. Traditionally, ischemia-reperfusion injury to the biliary system is considered to be the major risk factor for ITBL. Several other risk factors for ITBL have been identified, including the use of liver grafts donated after cardiac death, prolonged cold and warm ischemic times and use of University of Wisconsin preservation solution. In recent years however, impaired microcirculation of the peribiliary plexus (PBP) has been implicated as a possible risk factor. It is widely accepted that the PBP is exclusively provided by blood from the hepatic artery, and therefore, the role of the portal venous blood supply has not been considered as a possible cause for the development of ITBL. In this short report, we present three patients with segmental portal vein thrombosis and subsequent development of ITBL in the affected segments in the presence of normal arterial blood flow. This suggests that portal blood flow may have an important contribution to the biliary microcirculation and that a compromised portal venous blood supply can predispose to the development of ITBL.

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Section: Discussionmentioning

confidence: 99%

“…Biliary complications are a significant cause of morbidity and even mortality in patients after liver transplantation (1). Early biliary complications, either leakage or stenosis at the anastomotic site, are usually caused by surgical failure and occur within the first week after liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

The Importance of Portal Venous Blood Flow in Ischemic-Type Biliary Lesions after Liver Transplantation

Farid

Jonge

Slieker

et al. 2011

American Journal of Transplantation

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“…Therefore, we do not believe the addition of bile salts is necessary when livers are perfused for less than 10 hours. In fact, hydrophobic bile salts have been demonstrated to play a role in bile duct epithelial injury after liver transplantation and this could be considered an additional argument not to add bile salts to the perfusion fluid [19], [20], [21], [22]. On the other hand, due to the strong choleric effect of bile salts, bile production during ex vivo NMP will be higher when bile salts are added to the perfusion fluid.…”

Section: Discussionmentioning

confidence: 99%

Criteria for Viability Assessment of Discarded Human Donor Livers During Ex-Vivo Normothermic Machine Perfusion.

et al. 2014

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Although normothermic machine perfusion of donor livers may allow assessment of graft viability prior to transplantation, there are currently no data on what would be a good parameter of graft viability. To determine whether bile production is a suitable biomarker that can be used to discriminate viable from non-viable livers we have studied functional performance as well as biochemical and histological evidence of hepatobiliary injury during ex vivo normothermic machine perfusion of human donor livers. After a median duration of cold storage of 6.5 h, twelve extended criteria human donor livers that were declined for transplantation were ex vivo perfused for 6 h at 37uC with an oxygenated solution based on red blood cells and plasma, using pressure controlled pulsatile perfusion of the hepatic artery and continuous portal perfusion.

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“…Their multifactorial origin involves various events (risk factors) including ischemia due to hepatic artery thrombosis or prolonged cold and warm ischemia, use of University of Wisconsin solution vs. histidine tryptophan ketoglutarate, ABO incompatibility, extramural pressure by lymph nodes or tumour, recurrence of the original disease or it remains obscure. Also the altered bile composition with a significantly lower phospholipids/bile salts ratio after liver transplantation and graft steatosis may contribute to the pathogenesis of these complications (Buis et al, 2005(Buis et al, , 2009Pascher et al, 2005). Compared to anastomotic strictures, non-anastomotic strictures pose a higher risk of progressive disease with a severe outcome and limited graft survival.…”

Section: Non-anastomotic Hilar Strictures (Ischemic-type Biliary Lesimentioning

confidence: 99%

Biliary Complications After Liver Transplantation

Špičák¹,

Bartakova²

2012

Liver Transplantation - Technical Issues and Complications

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Altered bile composition after liver transplantation is associated with the development of nonanastomotic biliary strictures

Cited by 91 publications

References 54 publications

The Importance of Portal Venous Blood Flow in Ischemic-Type Biliary Lesions after Liver Transplantation

The Importance of Portal Venous Blood Flow in Ischemic-Type Biliary Lesions after Liver Transplantation

Criteria for Viability Assessment of Discarded Human Donor Livers During Ex-Vivo Normothermic Machine Perfusion.

Biliary Complications After Liver Transplantation

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