In liver transplantation, T tube bile represents total bile flow: Physiological and scintigraphic studies on biliary secretion of organic anions

The present study was performed to clarify the recovery of hepatocellular u ptake and the biliary secretion of bile acids during the first 14 days afte r orthotopic liver transplantation (OLT) and to determine the fraction of b ile flow appearing outside through the T tube and entering the duodenum. Th erefore, we determined primary and secondary bile acids in bile samples obt ained from the T tube at day 5 after OLT, while the T tube was permanently open, and at days 10 and 14 after OLT, i.e., 4 and 9 days after closure of the T tube, respectively, thus restoring enterohepatic bile acid circulatio n. In addition, we performed hepatobiliary scintigraphy using technetium 99 m-labeled [2,4,6 trimethyl-3-bromo]imino-diacetic acid (technetium 99m-BRID A) in 12 patients between days 4 and 17 after OLT. Chromatographic analyses of biliary bile acids showed no secondary bile acids during the first 5 da ys after OLT, as opposed to 10 and 14 days after OLT when enterohepatic cir culation was restored. Eleven patients with an uncomplicated postoperative course after OLT showed a significantly reduced hepatic uptake and biliary secretion of Tc-99m-BRIDA during the first days after OLT with progressive recovery. One patient with an acute allograft rejection episode showed almo st no uptake and only minimal secretion. The bile fraction appearing outsid e through the inserted T tube represented 94.6% +/- 6.2% of the injected (T C)-T-99m-BRIDA. We conclude that OLT results in markedly impaired hepatocel lular uptake and biliary secretion of organic anions. Simultaneously, bile acid synthesis is significantly reduced, which, in addition, diminishes bil e secretion of the graft. We show that T tube bile is a valid tool for bile physiological studies in patients in whom transplantation was successfully performed. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.