Background
Bile chemistry during normothermic ex situ perfusion of the liver (NESLiP) has been suggested to be an indicator of cholangiopathy. The normal range of biochemical variables in bile of livers undergoing NESLiP has not been defined, nor have published biliary viability criteria been assessed against instances of post-transplant non-anastomotic bile strictures (NAS).
Methods
The bile and perfusate chemistry of 200 livers undergoing NESLiP between 1st February 2018 and 30th October 2023 was compared. In addition, the chemistry of bile in 11 livers that underwent NESLiP and later developed NAS were selected and their bile chemistry also examined.
Results
In livers that did not develop cholangiopathy, concentrations of sodium, potassium and chloride were slightly higher in bile than perfusate, while the concentration of calcium was slightly lower. Bile was alkali and had a lower glucose concentration that perfusate. Cholangiocyte glucose reabsorption was shown to saturate at high perfusate concentrations, and was more impaired in DCD livers than DBD livers.
Published criteria failed to identify all livers that went on to develop NAS.
Conclusions
A significant false negative rate exists with current biliary viability criteria, probably reflecting the patchy and incomplete nature of the development of NAS in the biliary tree. The data presented here provide a benchmark for future assessment of bile duct chemistry during NESLiP.NIHR BTRU and NIHR Cambridge Biomedical Research Campu
