Liver Transplantation: Does Prolonged Storage Promote Non-Anastomatic Biliary Structures?

摘要

The occurrence of biliary stricutures in allografts following liver transplantation correlateswith the duration of preservation time. The correlation between preservation timeand biliary strictures suggests that anoxic or reperfusion injury of the bile duct epitheliumcauses stricture formation. However, the relative susceptibility of bile duct cells to anoxicor reoxygenation injury is unknown. Our aims were to determine the vulnerability of ratliver bile duct cells to anoxic and reoxygenation injury and to compare the results withhepatocytes. During anoxia, bile duct epithelial cells were significantly more resistant tocell killing than hepatocytes. Rates of cellular proteolysis were also 2.5-fold lower in bileduct cells than in hepatocytes during anoxia. In contrast to anoxia, reoxygenation ofanoxic cells increased cell killing of bile duct cells but improved viability of hepatocytes.The rate of toxic oxygen species formation by bile duct cells was 5-fold greater than inhepatocytes during reoxygenation. In addition, basal levels of glutathione are lower in bileduct cells than in hepatocytes. These data suggests that bile duct cells are more susceptibleto reoxygenation injury than to anoxia. These studies support the hypothesis thatreoxygenation injury during liver preservation leads to bile duct injury during livertransplantation.