Biliary pH, Bicarbonate and Glucose are Suitable Biomarkers of Bile Duct Viability During Normothermic Machine Perfusion of Donor Livers

A.P.M. Matton, Y.D.V. de Vries, L.C.B. Burlage, R.V.R. van Rijn, A.S.H.G. Gouw, V.E.D.M. de Meijer, R.J. Porte, T.L. Lisman

Friday 16 march 2018

10:50 - 11:00h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 13: Clinical

Background

Normothermic machine perfusion (NMP) is rapidly making its way into the clinic and can be used for viability assessment of human donor livers prior to transplantation. Thus far, however, selection criteria have only been based on hepatocyte function and injury, and no criteria have been established to assess bile duct injury.

Methods

Twenty-three human donor livers that were discarded for transplantation underwent a period of static cold storage and 6 hours of NMP upon arrival at our center. Biopsies of the extrahepatic bile duct were taken before and after NMP and subsequently semi-quantitatively scored using a modified scoring system. The median injury score between the two biopsies was used to divide livers into high and low biliary injury. Bile was collected during NMP for analyses.

Results

Biliary pH and biliary bicarbonate concentration were significantly higher in livers with low biliary injury compared to livers with high biliary injury, and biliary glucose and biliary LDH concentration were significantly lower in livers with low biliary injury. A biliary pH above 7.4, biliary bicarbonate concentration above 25 mmol/L and biliary glucose concentration below 20 mmol/L at 2.5 hours of NMP, as well as a biliary LDH concentration below 5000 mmol/L already at 30 min of NMP, strongly predict low histological bile duct injury. Furthermore, livers with low biliary injury had relatively low glucose concentration in bile in relation to perfusate, whereas livers with high biliary injury showed approximately a 1:1 ratio between glucose concentration in bile and perfusate.

Conclusions

This study provides hands-on parameters to assess bile duct injury during NMP, allowing researchers and surgeons to make better informed decisions in selecting donor livers that are suitable for transplantation.