Preservation of Bile Ductules Mitigates Bile Duct Loss

• Published in: American journal of transplantation Vol. 6; no. 11; pp. 2660 - 2671
• Main Authors: Van Den Heuvel, M. C., De Jong, K. P., Boot, M., Slooff, M. J. H., Poppema, S., Gouw, A. S. H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2006; Blackwell
• Subjects: Adolescent; Adult; Bile Ducts, Extrahepatic - pathology; Bile Ducts, Extrahepatic - physiopathology; Bile Ducts, Intrahepatic - pathology; Bile Ducts, Intrahepatic - physiopathology; Biliary tree; Biological and medical sciences; Cell Division; Child; Child, Preschool; chronic rejection; Humans; Infant, Newborn; Liver Function Tests; Liver Transplantation - pathology; Liver Transplantation - physiology; Medical sciences; Organ Preservation; Regeneration; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; transplantation; vascularization; Biliary tract; Preservation; Digestive system; Loss; Biliary tree; Transplantation; Homotransplantation; chronic rejection; Vascularization; Rejection; Regeneration; Chronic; Organ preservation; Treatment; Surgery; Graft; Tree
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01511.x

The finer branches of the biliary tree (FBBT) contain a regenerative compartment. We hypothesized that preservation of the FBBT together with its microvasculature will lead to recovery of biliary damage and prolonged preservation of bile ductules during the development of chronic liver allograft rejection. The interlobular bile ducts, portal bile ductules and extraportal biliary cells with and without microvessels were studied in sequential biopsies in five patients who fulfilled the Banff criteria of early chronic rejection (CR) (imminence group). Biopsies of CR patients (n = 12) served as controls. Biopsies were double immunostained with CD34 (microvessels) and cytokeratin 7 (biliary structures). Proliferation and proangiogenic activity were assessed with Ki67 and VEGF‐A immunostaining. Severe damage of bile ducts in the imminence group did not progress to significant bile duct loss. This was associated with a high proliferative activity in all biliary structures and preservation of the microvascular compartment. VEGF‐A expression was increased in all but the reperfusion biopsies. In conclusion, both regenerative activity of the FBBT and an intact microvascular compartment are associated with less damage of the biliary tree and could therefore be prerequisites for biliary regeneration. In sequential biopsies of five patients with evidence of liver transplant “chronic rejection”, both regenerative capacity of the finer branches of the biliary tree and intact microvascular compartment were associated with less biliary tree damage.