Assessment of Bile Production and Quality during Normothermic Ex Vivo Liver Perfusion to Predict Biliary Injury
1Multi Organ Transplant Program, Toronto General Hospital, Toronto, Canada
2Laboratory Medicine and Pathobiology, University Health Network, Toronto, Canada.
Meeting: 2018 American Transplant Congress
Abstract number: D51
Keywords: Bile duct, Liver, Liver preservation, Pig
Session Information
Session Name: Poster Session D: Ischemia Reperfusion Injury: Time to Change the Fate?
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background. Liver transplantation (LT) with donation after circulatory death (DCD)-grafts is associated with higher risk for biliary strictures. We evaluated bile production and quality during normothermic ex vivo liver perfusion (NEVLP) to assess biliary injury.
Methods. Pig-LT was performed after 5hrs NEVLP using heart-beating-donor (HBD-group) and DCD grafts with 30 and 60min warm ischemia (30'DCD-group, 60'DCD-group; n=5). Bile was collected hourly during perfusion and daily during 4 days survival. Markers of cholangiocyte function (pH, HCO3–, totalCO2, glucose), injury (AST, GGT, LDH) and cholesterol were assessed. Bile-duct histology was evaluated 3hrs post-reperfusion and on postoperative day (POD)4.
Results. All 15 pigs survived 4 days. AST-levels were higher in perfusate from 60'DCD-livers vs. HBD- and 30'DCD-livers at baseline, 2 and 4hrs of perfusion (p=0.003, p<0.001, p<0.001, respectively). Bile production was higher in the HBD-group at 1 and 2hrs of perfusion (p<0.001, p=0.002, respectively). No difference was detected in bile-pH and bile-HCO3–-levels. However, totalCO2 in bile was lower in the 60'DCD-group reaching significance at 2hrs of perfusion (mean totalCO2 (mmol/L):HBD/30'DCD/60'DCD=20±7/16±3/8±3, p=0.005). At 2hrs of perfusion, bile-glucose was detected in 4/5 60'DCD-livers vs. 2/5 30'DCD-livers and 1/5 HBD-livers (p=0.153). Bile-Cholesterol-levels were lower in DCD-groups with the biggest difference at 2hrs of perfusion (mean cholesterol-levels (mmol/L):HBD/30'DCD/60'DCD=1.16±0.6/1.54±0.53/0.65±0.5, p=0.078). Bile-AST, GGT and LDH were higher in the 60'DCD-group with significant differences on POD3 (p=0.031, p=0.011 and p=0.031, respectively). H&E-staining of the common bile-duct were similar, whereas positive Ki67-staining was only detected in the 60'DCD-group (2/5), indicating regeneration after high injury.
Conclusion. We determined significant differences in bile production and quality during NEVLP of livers with different grades of injury. Bile volume and quality at 2hrs of perfusion could be used as a marker for severity of bile duct injury.
CITATION INFORMATION: Kollmann D., Linares I., Ganesh S., Rosales R., Hamar M., Urbanellis P., Wiebe A., Yip P., Adeyi O., Selzner M., Selzner N. Assessment of Bile Production and Quality during Normothermic Ex Vivo Liver Perfusion to Predict Biliary Injury Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kollmann D, Linares I, Ganesh S, Rosales R, Hamar M, Urbanellis P, Wiebe A, Yip P, Adeyi O, Selzner M, Selzner N. Assessment of Bile Production and Quality during Normothermic Ex Vivo Liver Perfusion to Predict Biliary Injury [abstract]. https://atcmeetingabstracts.com/abstract/assessment-of-bile-production-and-quality-during-normothermic-ex-vivo-liver-perfusion-to-predict-biliary-injury/. Accessed May 16, 2025.« Back to 2018 American Transplant Congress