A Prospective Study Of Ischemia-Type Biliary Lesions After Liver Transplantation

The aim of this study was to verify the risk factors of ischemia-type biliary lesions (ITBL) through prospective studies and to observe the relationship between cold preservation injuries of the bile duct (CPI-BD) and ITBL. From August 2012 to July 2013, 50 patients who had orthotopic liver transplantation (OLT) in the Organ Transplantation Center, First Central Hospital of Tianjin, were enrolled and put into the ITBL group (n = 8) and the NITBL group (32 cases) according to their postoperative bile duct ischemic conditions, and confirmed by HE staining and TUNEL apoptotic staining, together with electron microscopy. The risk factors were defined by multivariate analysis, including cold ischemic time, intraoperative fresh frozen plasma use, anhepatic time and intraoperative erythrocyte usage. There were no significant differences in the survival rate (P = 0.599) and graft survival rate (P = 0.073) between the two groups, but there was a significant difference in the cold ischemic time (P = 0.033). From the multivariate analysis, the cold ischemic time, usage of intraoperative fresh frozen plasma and anhepatic time were not independent risk factors for ITBL after liver transplantation. Light microscopy and electron microscopy showed that the epithelial cells in the bile duct of Group ITBL gradually appeared to have more mitochondrial vacuolar degeneration, the cell gap widened, and the biliary fibroblasts and collagen cells also appeared to have different degrees of apoptosis. The cold ischemic time is the risk factor toward the epithelial injury in the biliary tract, and the prolongation of cold ischemic time has an obvious correlation with the injury of donated bile duct tissue.