title: Relationship between the histological appearance of the portal vein and development of ischemic-type biliary lesions after liver transplantation.
abstract: Ischemic-type biliary lesions (ITBLs) are a major cause of morbidity after liver transplantation (LT). Their assumed underlying pathophysiological mechanism is ischemia/reperfusion injury of the biliary tree, in which the portal circulation has been proposed recently to have a role. The aim of this study was to investigate whether early histological changes, particularly in the portal vein, predispose patients to ITBLs. A case-control study of 22 LT recipients was performed through a retrospective assessment of more than 30 histological parameters in 44 intraoperative liver biopsy samples taken after cold ischemia (time 0) and portal reperfusion (time 1). Eleven grafts developed ITBLs requiring retransplantation (the ITBL group), and 11 matched controls had normally functioning grafts 11 years after LT on average (the non-ITBL group). Additionally, 11 liver biopsy samples from hemihepatectomies performed for metastases of colorectal cancer (CRC) were assessed similarly. Analyses showed no significant histological differences at time 0 between the ITBL and non-ITBL groups. However, the time 1 biopsy samples from the ITBL group showed smaller portal vein branches (PVBs) significantly more often than the samples from the non-ITBL group, which also showed persisting paraportal collateral vessels. Larger PVBs and paraportal collateral vessels were also found in the CRC group. A morphometric analysis confirmed these findings and showed that PVB measurements were significantly lower for the ITBL group at time 1 versus the ITBL group at time 0 and the non-ITBL and CRC groups (they were largest in the CRC group). Thus, the PVB dimensions decreased in the ITBL group in comparison with the time 0 biopsy samples, and they were significantly smaller at time 1 in comparison with the dimensions for the non-ITBL and CRC groups. In conclusion, a smaller PVB lumen size in postreperfusion biopsy samples from liver grafts, suggesting a relatively decreased portal blood flow, is associated with a higher incidence of ITBLs. These findings support recent clinical studies suggesting a possible pathophysiological role of portal blood flow in the oxygenation of the biliary tree after LT.
authors.affiliation: Departments of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Waqar R R
authors.initials: WR
authors.lastname: Farid
authors.forename: Jeroen
authors.initials: J
authors.lastname: de Jonge
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Zondervan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Demirkiran
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Ron W F
authors.initials: RW
authors.lastname: de Bruin
authors.forename: Luc J W
authors.initials: LJ
authors.lastname: van der Laan
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology; D001659:Biliary Tract / Q000098:blood supply*; D001706:Biopsy; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010100:Oxygen / Q000737:chemistry; D011169:Portal Vein / Q000473:pathology*; D011183:Postoperative Complications; D012086:Reoperation; D015427:Reperfusion Injury / Q000473:pathology*; D012307:Risk Factors
chemical_list: D010100:Oxygen