Aims: To evaluate bile duct viability by assessing its microvascular quality using an innovative real-time oxygen tension device by testing different areas in both donor and recipient's side. The findings were subsequently correlated with histopathological results. As a secondary aim, differences in bile duct micro-oxygenation status were analysed according to several donor, recipient and technical factors.

Methods: Observational prospective cohort study with 18 patients included from November 2013 to September 2014. Tissue oxygen microtension measurements were made using Oxylite device in different areas of recipient and donor's bile duct intraoperatively after biliary anastomosis was made. Bile duct and hepatic artery biopsies were taken from donor and recipient.

Results: A total of 18 patients underwent liver transplantation with a median age of 53 years old (44-60) and MELD of 18. Mean oxygen microtension value in the graft bile duct at anastomosis level was 106 (92-118) mmHg, being 125 (108-134) mmHg 1.5 cm proximal to the hilar plate. Mean micro-oxygenation value in the bile duct recipient was 117 (100-150) mmHg, whilst a value of 138 (119-183) mmHg was observed 1.5 cms distal to the anastomosis. Tissue oxygen microtension was statistically higher in distal areas to section border of the biliary anastomosis, with an overall pO2 increase distal to the anastomosis of 17,9 mmHg (p<0,001) and 21,6 mmHg (p<0,001) in the graft and recipient, respectively. Biliary anastomosis was performed above the cystic duct insertion in the donor bile duct in 10 patients, with significant higher values of pO2 microtension (p=0.017). Histological injury grade 2-3 in biliary mural stroma and grade 1-3 in peribiliary vascular plexus of graft's bile duct graft were associated with lower tissue oxygen pressure, as well as injury grade 2 in biliary epithelium and grade 1-3 in peribiliary vascular plexus of recipient's bile duct were associated with lower micro-oxygenation (p<0,05).

Conclusions: Our results demonstrates that terminal border of donor and recipient bile duct are low-vascularized areas. Tissue microoxygenation improves significantly in areas close to the hilar plate and to the duodenum in the donor and recipient's sides, respectively. Histopathological findings of bile duct injury are associated to worst tissue microoxigenation.

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