Effect of Different Bile Duct Flush Solutions on Biliary Tract Preservation Injury of Donated Livers for Transplantation

ObjectivesThe objective of this study was to explore the effect of various bile duct flush (BDF) solutions on biliary tract preservation of donated livers in rats.MethodsWe studied the effects of BDF solutions and cold ischemic times on biliary tract preservation, using 2 kinds of solutions: (1) BDFa with normal saline (NS), or hypertonic citrate-adenine kidney preservation in vivo (HCA), and (2) BDFb with University of Wisconsin solution (UW), or histidine-tryptophan-ketoglutarate solution (HTK). The cold ischemic times (CIT) were 4, 8, or 12 hours. Forty-five healthy male Wistar rats were randomly divided into 9 groups of 5 rats each using a [L9(34)] orthogonal table. Biliary tract tissues were examined at the corresponding cold preservation times for the following: microscopic changes in bile duct cells; TUNEL (Transferase-mediated, dUTP-bitin nick end labeling) procedure assays apoptotic indices (AI) of endothelial cells in the biliary tract; ultrastructural changes; and average volumes (V) and density (Nd) of mitochondria in endothelial cells calculated using an image analysis system. The results were evaluated by analysis of variance (ANOVA) and direct analysis by an orthogonal design.ResultsAI of biliary tract endothelial cells showed significance (P < .01) of cold preservation of the biliary tract of donor liver with BDFa or BDFb and CIT; furthermore, HCA, HTK, and 4-hour CIT were all ideal. V and Nd of mitochondrial endothelial cells were significantly increased (P < .01) with BDFa, BDFb, and CIT; furthermore, factors HCA, HTK, and 4-hour CIT were all ideal.ConclusionsCold preservation injuries to the biliary tract of a donor liver may be greatly decreased by efficient and sufficient flushing of the bile tract. A suitable bile duct solution greatly decreases cold preservation injuries and protects endothelial cells.