Ischemia-Reperfusion Injury and Ischemic-Type Biliary Lesions following Liver Transplantation

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  • Raffaele Cursio
    Service de Chirurgie et Transplantation Hépatique, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, 151 Route Saint Antoine de Ginestière, B.P. 3079, 06202 Nice Cedex 2, France
  • Jean Gugenheim
    Service de Chirurgie et Transplantation Hépatique, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, 151 Route Saint Antoine de Ginestière, B.P. 3079, 06202 Nice Cedex 2, France

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<jats:p>Ischemia-reperfusion (I-R) injury after liver transplantation (LT) induces intra- and/or extrahepatic nonanastomotic ischemic-type biliary lesions (ITBLs). Subsequent bile duct stricture is a significant cause of morbidity and even mortality in patients who underwent LT. Although the pathogenesis of ITBLs is multifactorial, there are three main interconnected mechanisms responsible for their formation: cold and warm I-R injury, injury induced by cytotoxic bile salts, and immunological-mediated injury. Cold and warm ischemic insult can induce direct injury to the cholangiocytes and/or damage to the arterioles of the peribiliary vascular plexus, which in turn leads to apoptosis and necrosis of the cholangiocytes. Liver grafts from suboptimal or extended-criteria donors are more susceptible to cold and warm I-R injury and develop more easily ITBLs than normal livers. This paper, focusing on liver I-R injury, reviews the risk factors and mechanisms leading to ITBLs following LT.</jats:p>

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