Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
The National Institute of Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom.
Transplantation. 2024 Jun 1;108(6):1383-1393. doi: 10.1097/TP.0000000000004944. Epub 2024 Feb 27.
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).
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.
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.
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.
在常温体外肝脏灌注（NESLiP）过程中，胆汁化学特性被认为是胆管病的一个指标。尚未确定 NESLiP 过程中胆汁的生化变量的正常范围，也没有根据移植后非吻合口胆汁狭窄（NAS）的情况评估已发表的胆汁活力标准。
比较了 200 例于 2018 年 2 月 1 日至 2023 年 10 月 30 日期间接受 NESLiP 的肝脏的胆汁和灌注液化学特性。此外，选择了 11 例接受 NESLiP 后出现 NAS 的肝脏，并对其胆汁化学特性进行了检查。
在未发生胆管病的肝脏中，胆汁中的钠、钾和氯浓度略高于灌注液，而钙浓度略低于灌注液。胆汁呈碱性，葡萄糖浓度低于灌注液。胆细胞的葡萄糖重吸收在高灌注液浓度下达到饱和，并且在循环死亡供体的肝脏中比在脑死亡供体的肝脏中受损更严重。已发表的标准未能识别所有发展为 NAS 的肝脏。
目前的胆汁活力标准存在显著的假阴性率，这可能反映了胆管树中 NAS 发展的局灶性和不完全性。此处提供的资料为未来评估 NESLiP 期间胆管化学特性提供了基准。
