Course of the initial epithelial lesions associated with autologous bile duct replacement

Doillon, Charles J.; Dureau, G; Chignier, E; Clendinnen, Guy; Eloy, R.

doi:10.1016/0002-9610(81)90154-9

The American Journal of Surgery

1981

DOI: 10.1016/0002-9610(81)90154-9

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Course of the initial epithelial lesions associated with autologous bile duct replacement

Charles J. Doillon¹,

G Dureau²,

E Chignier³

et al.

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1986

1999

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Cited by 2 publications

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Reconstructive Surgery for Ischemic-Type Lesions at the Bile Duct Bifurcation After Liver Transplantation

Schlitt

Meier²,

Nashan³

et al. 1999

Annals of Surgery

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ObjectiveTo assess the feasibility, morbidity, mortality, and clinical success rate of surgical reconstruction of the biliary system in patients with ischemic-type biliary lesions in their liver graft. Summary Background DataAfter liver transplantation, strictures in the biliary tree with secondary sludge formation can occur in the absence of vascular problems. Jaundice, pruritus, and recurrent cholangitis are predominant clinical features leading to considerable morbidity. Interventional measures are the first-line treatment but are frequently only of transient success. Retransplantation is usually considered when interventional treatment is not effective. MethodsSurgical exploration and reconstruction was performed in 17 patients with ischemic-type biliary stnctures at a median of 2 years after liver transplantation. Findings during surgery, surgical strategies, and postsurgical courses are described. Clinical symptoms and biochemical parameters of cholestasis and liver function were analyzed in the postsurgical course. ResultsDuring surgery, all 17 patients were found to have strictures or sclerotic changes involving the hepatic bifurcation and extrahepatic bile duct. Sludge or stones were present in nine patients. In 14 patients with viable bile ducts proximal to the bifurcation, surgical reconstruction was performed by resection of the bifurcation and hepaticojejunostomy. In three patients with more extensive biliary destruction, portoenterostomy with or without peripheral hepatojejunostomy was performed. The prevalence rate of biliary infection at surgery was 93%; the predominant organisms were Candida and enterococci. The perioperative mortality rate was 0%. Clinical symptoms and biochemical parameters became normal or were considerably improved in 14 of 16 patients (88%). ConclusionsThe hepatic bifurcation seems to be a predominant site for ischemic-type biliary changes after liver transplantation. Surgical treatment by resection of the bifurcation and reconstruction by high hepaticojejunostomy is a safe and highly effective approach leading to cure or persistent major improvement in most patients.

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Reconstructive Surgery for Ischemic-Type Lesions at the Bile Duct Bifurcation After Liver Transplantation

Schlitt

Meier²,

Nashan³

et al. 1999

Annals of Surgery

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A LIGHT AND ELECTRON MICROSCOPIC STUDY OF THE REGENERATIVE EPITHELIUM IN THE INTRAHEPATIC BILE DUCT: Experimental Study of Local Direct Instillation of Paraquat Into the Intrahepatic Bile Ducts of Rats

Matsumoto

Matsumori

Hosokawa

et al. 1986

Acta Pathologica Japonica

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To date, no reliable report on the regeneration of the intrahepatic bile duct epithelium following damage to the duct has been published. In this study, a direct instillation of paraquat dichloride into the intrahepatic bile ducts of rats was carried out, and the livers were examined under light and electron microscopy. One hour after treatment, the biliary epithelia showed degeneration and necrosis, and these changes remained for a considerable period in a large majority of the ducts examined.Three weeks after instillation, low columnar epithelium consisting of hyperchromatic nuclei and eosinophilic cytoplasm was present in a medium-sized bile duct, which was collared by marked periductal fibrosis. Electron microscopically, the eosinophilic epithelium showed a marked increase in the number of rough endoplasmic reticula, ribosomes, mitochondria, and filamentous structures, suggesting an active viability of the cell. Subsequently, the eosinophilic cells were replaced by normal-appearing epithelium, not associated with the periductal fibrosis. The data suggest that an epithelial regeneration occurred in the intrahepatic duct following injury and that this activity may be similar to that of the extrahepatic bile duct epithelium.

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Course of the initial epithelial lesions associated with autologous bile duct replacement

Cited by 2 publications

References 12 publications

Reconstructive Surgery for Ischemic-Type Lesions at the Bile Duct Bifurcation After Liver Transplantation

Reconstructive Surgery for Ischemic-Type Lesions at the Bile Duct Bifurcation After Liver Transplantation

A LIGHT AND ELECTRON MICROSCOPIC STUDY OF THE REGENERATIVE EPITHELIUM IN THE INTRAHEPATIC BILE DUCT: Experimental Study of Local Direct Instillation of Paraquat Into the Intrahepatic Bile Ducts of Rats

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