Research ArticleBile duct damage after cold storage of deceased donor livers predicts biliary complications after liver transplantation

Background & AimsThe aim of this study was to examine the development of biliary epithelial damage between organ retrieval and transplantation and its clinical relevance for patients.MethodsCommon bile duct samples during donor hepatectomy, after cold storage, and after reperfusion were compared to healthy controls by hematoxylin and eosin (H&E) staining and immunofluorescence for tight junction protein 1 and Claudin-1. A bile duct damage score to quantify biliary epithelial injury was developed and correlated with recipient and donor data and patient outcome.ResultsControl (N = 16) and donor hepatectomy bile ducts (N = 10) showed regular epithelial morphology and tight junction architecture. After cold storage (N = 37; p = 0.0119), and even more after reperfusion (N = 62; p = 0.0002), epithelial damage, as quantified by the bile duct damage score, was markedly increased, and both tight junction proteins were detected with inappropriate morphology. Patients with major bile duct damage after cold storage had a significantly increased risk of biliary complications (relative risk 18.75; p <0.0001) and graft loss (p = 0.0004).ConclusionsIn many cases, the common bile duct epithelium shows considerable damage after cold ischemia with further damage occurring after reperfusion. The extent of epithelial damage can be quantified by our newly developed bile duct damage score and is a prognostic parameter for biliary complications and graft loss. Possibly, in an intraoperative histological examination, this bile duct damage score may influence decision-making in transplantation surgery.