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PhD ceremony Ms. S. Op den Dries: Bile duct injury in liver transplantation. Study on etiology and the protective role of machine perfusion

When:We 13-11-2013 at 16:15

PhD ceremony: Ms. S. Op den Dries, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Bile duct injury in liver transplantation. Study on etiology and the protective role of machine perfusion

Promotor(s): prof. R.J. Porte, prof. J.A. Lisman

Faculty: Medical Sciences

Non-anastomotic biliary strictures (NAS) are a major complication after liver transplantation. The development of strictures (narrowing) of the bile ducts is characteristic of this complication, often leading to morbidity and the need for re-transplantation. The studies described in this thesis resulted in a better understanding of the causes of NAS and provide new strategies to prevent bile duct injury and the subsequent formation of NAS.

The high incidence of NAS after donation after cardiac death (21-33%) compared to donation after brain death (1-13%), demonstrates the significant role of lack of oxygen (ischemia) in the development of NAS. In this thesis, severe injury to the bile duct epithelium (the lining of the bile duct) was discovered in the majority of donor livers at the end of the cold preservation period. Moreover, it was discovered that the lack of regeneration of bile duct epithelium, rather than the amount of injury, determines whether a liver will develop NAS after transplantation. In order to maintain this regeneration capacity of the bile ducts, it is essential to protect vulnerable livers (older, fatter, donation after cardiac death) from injury induced by cold ischemia.

This thesis demonstrates that machine perfusion creates new opportunities for improved donor organ preservation, including the protection of vulnerable bile ducts by providing an oxygen-rich environment. It was demonstrated that machine perfusion allows human donor livers to be kept ‘alive’ outside the human body. Machine perfusion allows assessment of donor livers, which can be used to decide whether a liver is suitable for transplantation.

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