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Bile Chemistry During Ex Situ Normothermic Liver Perfusion Does Not Always Predict Cholangiopathy.

Accepted version
Peer-reviewed

Type

Article

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Authors

Watson, Christopher JE 
Gaurav, Rohit 
Swift, Lisa 
Fear, Corrina 
Allison, Michael ED 

Abstract

BACKGROUND: Bile chemistry during normothermic ex situ liver perfusion (NESLiP) has been suggested to be an indicator of cholangiopathy. The normal range of biochemical variables in bile of livers undergoing NESLiP has not been defined, nor have published biliary viability criteria been assessed against instances of posttransplant nonanastomotic bile strictures (NASs). METHODS: The bile and perfusate chemistry of 200 livers undergoing NESLiP between February 1, 2018, and October 30, 2023, was compared. In addition, 11 livers that underwent NESLiP and later developed NAS were selected and their bile chemistry was also examined. RESULTS: In livers that did not develop cholangiopathy, concentrations of sodium, potassium, and chloride were slightly higher in bile than in perfusate, whereas the concentration of calcium was slightly lower. Bile was alkali and had a lower glucose concentration than perfusate. Cholangiocyte glucose reabsorption was shown to saturate at high perfusate concentrations and was more impaired in livers donated after circulatory death than in livers donated after brain death. Published criteria failed to identify all livers that went on to develop NASs. CONCLUSIONS: A significant false-negative rate exists with current biliary viability criteria, probably reflecting the patchy and incomplete nature of the development of NASs in the biliary tree. The data presented here provide a benchmark for future assessment of bile duct chemistry during NESLiP.

Description

Keywords

32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 3204 Immunology, Digestive Diseases, Liver Disease

Journal Title

Transplantation

Conference Name

Journal ISSN

0041-1337
1534-6080

Volume Title

Publisher

Ovid Technologies (Wolters Kluwer Health)
Sponsorship
NIHR BTRU and NIHR Cambridge Biomedical Research Campus