Histological examination and evaluation of donor bile ducts received during orthotopic liver transplantation—a morphological clue to ischemic-type biliary lesion?

Abstract

Ischemic-type biliary lesions (ITBL) belong to a group of biliary disorders that are regarded as the major complication in patients with orthotopic liver transplantation (OLT). We performed histological evaluation of donor common bile ducts received during OLT to find morphological clues to the pathomechanisms of ITBL. We investigated 93 grafts of 92 patients (recipients: mean age, 56.5 years; underlying disease: hepatocellular carcinoma (n = 45), alcoholic cirrhosis (n = 16), viral hepatitis with cirrhosis (n = 9), retransplantations (n = 9), others (n = 14); donors: mean age, 53.2 years). Donor common bile ducts were received after recirculation of the hepatic artery prior to biliary end-to-end anastomosis and routinely processed. Statistical evaluation was performed by chi-square analysis and multivariate analysis using a logistic regression model. With regard to ITBL (observed in 19.4 %), the following phenomena were found to be statistically relevant: necrosis of the bile duct wall, arteriolonecrosis, vascular lesions (such as subintimal edema), and intramural bleeding (P < 0.001, P < 0.001, P = 0.029, and P = 0.031, respectively). In logistic regression analysis, arteriolonecrosis was the only parameter with significance (P = 0.001). Based on these results on the morphology of the donor common bile duct, we conclude that these phenomena of vascular damage, reflecting microangiopathy, play a major role in the pathogenesis of ITBL.

End‐ischemic machine perfusion reduces bile duct injury in donation after circulatory death rat donor livers independent of the machine perfusion temperature

“…Recently, 3 independent clinical studies have demonstrated that major mucosal cell loss (>50% biliary epithelial injury) and mural stroma necrosis (<50% necrotic cells) of the large bile duct is present in more than 80% of human donor livers (both DBD and DCD) at the end of SCS and subsequent reperfusion. 4,24,27 Although biliary preservation injury is apparently almost universally present, only a minority ) concentration and pH detected in bile. Biliary bicarbonate concentrations were significantly higher in livers that had been preserved by end-ischemic HMP, COR, or SNMP compared to livers that underwent only SCS (*P < 0.05).…”

Ex vivo Normothermic Machine Perfusion and Viability Testing of Discarded Human Donor Livers

“…Paraffin-embedded slides of extrahepatic bile ducts were prepared for H&E staining and complementary staining with periodic acid-Schiff after diastase digestion. Slides of the extrahepatic bile ducts were graded according to a systematic scoring system of bile duct injury as first described by Hansen et al (14). All liver and bile duct slides were examined by an experienced liver pathologist (ASH Gouw) using light microscopy.…”

Perfusion machines and hepatocellular carcinoma: a good match between a marginal organ and an advanced disease?

“…After reperfusion, the production of reactive oxygen species, cytokines secretion, neutrophil infiltration and the impaired hepatic microcirculation provoke inflammation, cell death, loss of functioning parenchyma and ultimately organ failure (36,37). Moreover, cholangiocytes are more susceptible to IRI and extended damage of the biliary epithelium is visible at the end of preservation of virtually all grafts (38,39). Peribiliary vascular plexus and glands (containing the precursor's niche) are also damaged by microthrombi and necrosis, leading to impaired regeneration of the biliary epithelium (40).…”