EVIDENCE OF PRESERVATION INJURY TO BILE-DUCTS BY BILE-SALTS IN THE PIG AND ITS PREVENTION BY INFUSIONS OF HYDROPHILIC BILE-SALTS

Preservation injury to bile ducts is a serious problem in liver transp lantation, especially when preservation exceeds 12 hours. The authors hypothesized that the injury was caused by contact of bile ducts with bile salts during cold preservation and might be preventable by infusi on of more hydrophilic bile salts. Swine livers were harvested after i ntraportal infusions of saline (control), of the hydrophobic bile salt taurodeoxycholate, or of the hydrophilic bile salts tauroursodeoxycho late or dehydrocholate, The effect of infusing a combination of hydrop hilic and hydrophobic bile acids was also studied. Bile samples were t aken before and during the infusions, Then Livers were perfused with U W solution, ducts were flushed retrograde with UW, and livers were sto red at 0 to 1 degrees C for 20 hours, Bile ducts were harvested after preservation, and coded microscopic slides of the specimens were exami ned by Light microscopy, There was large variability in baseline bile salt concentration, Injury after preservation consisted of sloughing a nd pyknosis Of surface and glandular epithelium. The histologic injury score determined after preservation was directly related to bile salt concentration in bile ducts at the time of hushing During bile salt i nfusions, the infused bile salt replaced most or all of the other bile salts present in bile. Severe postpreservation injury of intrahepatic ducts occurred after taurodeoxycholate infusions, but injury was mini mal when either of the two hydrophilic bile salts was infused, The mix ture of bile acids produced intermediate results. Retrograde flushing with UW does not prevent injury to intrahepatic ducts. The authors con clude that the injury is caused by contact with bile salts, is depende nt on bile salt concentration and composition, and is preventable.