In liver transplantation, T tube bile represents total bile flow: physiological and scintigraphic studies on biliary secretion of organic anions.
The present study was performed to clarify the recovery of hepatocellular uptake and the biliary secretion of bile acids during the first 14 days after orthotopic liver transplantation (OLT) and to determine the fraction of bile flow appearing outside through the T tube and entering the duodenum. Therefore, we determined primary and secondary bile acids in bile samples obtained from the T tube at day 5 after OLT, while the T tube was permanently open, and at days 10 and 14 after OLT, i.e., 4 and 9 days after closure of the T tube, respectively, thus restoring enterohepatic bile acid circulation. In addition, we performed hepatobiliary scintigraphy using technetium 99m-labeled [2,4,6 trimethyl-3-bromo]imino-diacetic acid (technetium 99m-BRIDA) in 12 patients between days 4 and 17 after OLT. Chromatographic analyses of biliary bile acids showed no secondary bile acids during the first 5 days after OLT, as opposed to 10 and 14 days after OLT when enterohepatic circulation was restored. Eleven patients with an uncomplicated postoperative course after OLT showed a significantly reduced hepatic uptake and biliary secretion of 99mTc-BRIDA during the first days after OLT with progressive recovery. One patient with an acute allograft rejection episode showed almost no uptake and only minimal secretion. The bile fraction appearing outside through the inserted T tube represented 94.6% +/- 6.2% of the injected 99mTc-BRIDA. We conclude that OLT results in markedly impaired hepatocellular uptake and biliary secretion of organic anions. Simultaneously, bile acid synthesis is significantly reduced, which, in addition, diminishes bile secretion of the graft. We show that T tube bile is a valid tool for bile physiological studies in patients in whom transplantation was successfully performed.
Lenzen
R
R
Division of Gastroenterology/Hepatology, Virchow Klinikum der Humboldt Universität, Berlin, Federal Republic of Germany.
Bähr
A
A
Eichstädt
H
H
Marschall
U
U
Bechstein
W O
WO
Neuhaus
P
P
D000328:Adult; D000814:Aniline Compounds; D001646:Bile / Q000737:chemistry; D001647:Bile Acids and Salts / Q000096:biosynthesis* / Q000737:chemistry; D001652:Bile Ducts / Q000378:metabolism*; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011184:Postoperative Period; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D000814:Aniline Compounds; D001647:Bile Acids and Salts; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C046767:technetium Tc 99m iminodiacetic acid; C034837:technetium Tc 99m mebrofenin; D005998:Glycine