Injury to peribiliary glands and vascular plexus before liver transplantation predicts formation of non-anastomotic biliary strictures

Op den Dries, S., Westerkamp, A. C., Karimian, N., Gouw, A. S. H., Bruinsma, B. G., Markmann, J. F., Lisman, T., Yeh, H., Uygun, K., Martins, P. N. & Porte, R. J., Jun-2014, In : Journal of Hepatology. 60, 6, p. 1172-1179 8 p.

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  • Injury to peribiliary glands and vascular plexus before liver transplantation

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  • Sanna Op den Dries
  • Andrie C. Westerkamp
  • Negin Karimian
  • Annette S. H. Gouw
  • Bote G. Bruinsma
  • James F. Markmann
  • Ton Lisman
  • Heidi Yeh
  • Korkut Uygun
  • Paulo N. Martins
  • Robert J. Porte

Background & Aims: The peribiliary glands of large bile ducts have been identified as a niche of progenitor cells that contribute to regeneration of biliary epithelium after injury. We aimed to determine whether injury to the peribiliary glands of donor livers is a risk factor for development of non-anastomotic biliary strictures (NAS) after liver transplantation.

Methods: In 128 liver transplant procedures, biopsies were taken from the donor bile duct and injury was assessed using an established histological grading system. Histological severity of injury was subsequently compared in liver grafts that later developed biliary structures vs. uncomplicated liver grafts.

Results: Luminal biliary epithelial loss >50% was observed in 91.8% of the grafts before transplantation, yet NAS occurred in only 16.4%. Periluminal peribiliary glands were more severely injured than deep peribiliary glands located near the fibromuscular layer (>50% loss in 56.9% vs. 17.5%, respectively; p 50% loss in 50.0% vs. 9.8%, respectively; p = 0.004). In parallel, injury of the peribiliary vascular plexus was more severe in livers that developed NAS, compared to grafts without NAS (>50% vascular changes in 57.1% vs. 20.3%; p = 0.006).

Conclusion: Injury of peribiliary glands and vascular plexus before transplantation is strongly associated with the occurrence of biliary strictures after transplantation. This suggests that insufficient regeneration due to loss of peribiliary glands or impaired blood supply may explain the development of biliary strictures. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.

Original languageEnglish
Pages (from-to)1172-1179
Number of pages8
JournalJournal of Hepatology
Issue number6
Publication statusPublished - Jun-2014


  • Bile duct injury, Donation after cardiac death, Non-anastomotic biliary strictures, Biliary complications, Ischemic cholangiopathy, Regeneration, Ischemic type biliary injury, Liver transplantation, BILE-DUCTS, MACHINE PERFUSION, CARDIAC DEATH, COLD-STORAGE, DONOR LIVERS, CELLS, COMPLICATIONS, CONSEQUENCES, REGENERATION, ISCHEMIA

ID: 15160379