Characteristics of biliary lipid metabolism after liver transplantation

✍ Scribed by Dr. Bo-Göran Ericzon; Sharif Eusufzai; Keiichi Kubota; Kurt Einarsson; Bo Angelin

• Publisher: John Wiley and Sons
• Year: 1990
• Tongue: English
• Weight: 685 KB
• Volume: 12
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840120524

✦ Synopsis

Biliary lipid metabolism was studied after 10 liver transplantations with continuous drainage of bile. Within 3 wk after transplantation, the new liver produced bile with concentrations of biliary lipids in agreement with those reported for T-tube bile in cholecystectolized nontransplanted subjects. Al- though changes in biliary lipid composition occurred swiftly in response to various forms of disturbed liver function, they did not provide substantially more information than did standard serum tests or simple measurements of bile flow in most patients. Secretion rates of phaepholipids and cholesterol were found to be completely bile acid dependent. For each micromole of bile acids, 0.22 and 0.08 pmol of phospholipids and cholesterol were secreted, respectively. When bile flow was related to bile acid output, a linear relationship was found (r = 0.89), with a positive intercept indicating a bile acid-independent bile flow of approximately 44 pVmin. Analysis of individual bile acids showed almost exclusively primary bile acids. The relative proportion of chenodeoxycholic acid was more prominent during the first days after transplantation. Different explanations for this are discussed. (HEPA-TOLOGY 1990;12: 1221-1228.)

Production of bile is the first reliable sign of organ functioning after liver transplantation. The color and viscosity of the bile is clinically monitored from the first drops produced intraoperatively until the T tube or choledochus catheter is clamped or removed 2 to 4 wk later. Changes in color and/or flow rate of bile may indicate poor graft function owing to ischemic damage, vascular thromboses or rejection episodes. However, very little information on the biochemical composition of bile from the transplanted liver has been published t 1-3).

In addition to the possible clinical importance of determining changes in bile composition in response to the insertion of a new liver, the model of liver transplantation offers a unique possibility to address specific