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Impact of Machine Perfusion on Biliary Complications after Liver Transplantation

1
Department of Surgery & Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland
2
The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham B15 2TH, UK
3
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; https://doi.org/10.3390/ijms19113567
Received: 2 October 2018 / Revised: 1 November 2018 / Accepted: 5 November 2018 / Published: 12 November 2018
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Abstract

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

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Int. J. Mol. Sci. EISSN 1422-0067 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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