title: Delayed rearterialization unlikely leads to nonanastomotic stricture but causes temporary injury on bile duct after liver transplantation.
abstract: Nonanastomotic strictures (NAS) are common biliary complications after liver transplantation (LT). Delayed rearterialization induces biliary injury in several hours. However, whether this injury can be prolonged remains unknown. The correlation of this injury with NAS occurrence remains obscure. Different delayed rearterialization times were compared using a porcine LT model. Morphological and functional changes in bile canaliculus were evaluated by transmission electron microscopy and real-time PCR. Immunohistochemistry and TUNEL were performed to validate intrahepatic bile duct injury. Three months after LT was performed, biliary duct stricture was determined by cholangiography; the tissue of common bile duct was detected by real-time PCR. Bile canaliculi were impaired in early postoperative stage and then exacerbated as delayed rearterialization time was prolonged. Nevertheless, damaged bile canaliculi could fully recover in subsequent months. TNF-α and TGF-β expressions and apoptosis cell ratio increased in the intrahepatic bile duct only during early postoperative period in a time-dependent manner. No abnormality was observed by cholangiography and common bile duct examination after 3 months. Delayed rearterialization caused temporary injury to bile canaliculi and intrahepatic bile duct in a time-dependent manner. Injury could be fully treated in succeeding months. Solo delayed rearterialization cannot induce NAS after LT.
authors.affiliation: Department of General Surgery, Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Jiazhong
authors.initials: J
authors.lastname: Wang
authors.forename: Peng
authors.initials: P
authors.lastname: Yang
authors.forename: Hongwei
authors.initials: H
authors.lastname: Lu
authors.forename: Le
authors.initials: L
authors.lastname: Lu
authors.forename: Jinlong
authors.initials: J
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Yanxia
authors.initials: Y
authors.lastname: Duan
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Yiming
authors.initials: Y
authors.lastname: Li
mesh_terms: D000818:Animals; D001653:Bile Ducts, Intrahepatic; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000209:etiology*; D004195:Disease Models, Animal; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D018919:Neovascularization, Physiologic; D011183:Postoperative Complications; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors
keywords: biliary injury; delayed rearterialization; nonanastomotic strictures; warm ischemia