REPERFUSION DAMAGE TO THE BILE CANALICULI IN TRANSPLANTED HUMAN LIVER

In 19 patients who have undergone orthotopic liver transplantation (OL T), the trend and degree of cholestasis was statistically monitored in terms of plasma levels of L-gamma-glutamyl transferase (GGT) and tota l bilirubin. In addition, the ultrastructure of the bile canaliculus w as examined during the entire OLT procedure, i.e., during explantation , cold ischemia, and after 60 to 90 minutes of organ reperfusion, Chol estasis was evident from the second day after surgery, with a peak aft er approximately 10 to 16 days, Defined, small changes in the function al state of actin filaments were noted in the bile canalicular area af ter prolonged ischemia, But the morphological status of the bile canal iculi changed dramatically after reperfusion, In fact, the mean area a nd perimeter of the canaliculi had increased significantly, and there was a marked loss in the number of bile microvilli per unit of canalic ular area. The bile canaliculus appears to be one of the liver structu res most susceptible to ischemia-reperfusion damage. A series of bioch emical changes occurring during ischemia and after reoxygenation of th e transplanted liver, especially, would provide a reason for the obser ved early morphological damage of the bile canaliculus, which, in turn , would explain the cholestasis of these patients in the first posttra nsplantation period.