Next Article in Journal
Targeting Cancer with Phytochemicals via Their Fine Tuning of the Cell Survival Signaling Pathways
Next Article in Special Issue
YAP Activation Drives Liver Regeneration after Cholestatic Damage Induced by Rbpj Deletion
Previous Article in Journal
Relative Contribution of PIN-Containing Secretory Vesicles and Plasma Membrane PINs to the Directed Auxin Transport: Theoretical Estimation
Previous Article in Special Issue
Metabolomic Profiling of Portal Blood and Bile Reveals Metabolic Signatures of Primary Sclerosing Cholangitis
Article Menu
Issue 11 (November) cover image

Export Article

Open AccessReview

Impact of Machine Perfusion on Biliary Complications after Liver Transplantation

Department of Surgery & Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland
The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham B15 2TH, UK
NIHR Liver Biomedical Research Unit, University Hospitals Birmingham, Birmingham B15 2TH, UK
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2018, 19(11), 3567;
Received: 2 October 2018 / Revised: 1 November 2018 / Accepted: 5 November 2018 / Published: 12 November 2018
PDF [5107 KB, uploaded 12 November 2018]


We describe in this review the different types of injuries caused to the biliary tree after liver transplantation. Furthermore, we explain underlying mechanisms and why oxygenated perfusion concepts could not only protect livers, but also repair high-risk grafts to prevent severe biliary complications and graft loss. Accordingly, we summarize experimental studies and clinical applications of machine liver perfusion with a focus on biliary complications after liver transplantation. Key points: (1) Acute inflammation with subsequent chronic ongoing liver inflammation and injury are the main triggers for cholangiocyte injury and biliary tree transformation, including non-anastomotic strictures; (2) Hypothermic oxygenated perfusion (HOPE) protects livers from initial oxidative injury at normothermic reperfusion after liver transplantation. This is a unique feature of a cold oxygenation approach, which is effective also end-ischemically, e.g., after cold storage, due to mitochondrial repair mechanisms. In contrast, normothermic oxygenated perfusion concepts protect by reducing cold ischemia, and are therefore most beneficial when applied instead of cold storage; (3) Due to less downstream activation of cholangiocytes, hypothermic oxygenated perfusion also significantly reduces the development of biliary strictures after liver transplantation. View Full-Text
Keywords: hypothermic oxygenated perfusion (HOPE); cholangiocyte injury; mitochondria hypothermic oxygenated perfusion (HOPE); cholangiocyte injury; mitochondria

Graphical abstract

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

Share & Cite This Article

MDPI and ACS Style

Schlegel, A.; Dutkowski, P. Impact of Machine Perfusion on Biliary Complications after Liver Transplantation. Int. J. Mol. Sci. 2018, 19, 3567.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics



[Return to top]
Int. J. Mol. Sci. EISSN 1422-0067 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top