In liver transplantation, T tube bile represents total bile flow: Physiological and scintigraphic studies on biliary secretion of organic anions

Abstract

The present study was performed to clarify the recovery of hepatocellular uptake and the biliary secretion of bile acids during the first 14 days after orthotopic liver transplantation (OLT) and to determine the fraction of bile flow appearing outside through the T tube and entering the duodenum. Therefore, we determined primary and secondary bile acids in bile samples obtained from the T tube at day 5 after OLT, while the T tube was permanently open, and at days 10 and 14 after OLT, i.e., 4 and 9 days after closure of the T tube, respectively, thus restoring enterohepatic bile acid circulation. In addition, we performed hepatobiliary scintigraphy using technetium 99m-labeled [2,4,6 trimethyl-3-bromo]imino-diacetic acid (technetium 99m-BRIDA) in 12 patients between days 4 and 17 after OLT. Chromatographic analyses of biliary bile acids showed no secondary bile acids during the first 5 days after OLT, as opposed to 10 and 14 days after OLT when enterohepatic circulation was restored. Eleven patients with an uncomplicated postoperative course after OLT showed a significantly reduced hepatic uptake and biliary secretion of 99m Tc-BRIDA during the first days after OLT with progressive recovery. One patient with an acute allograft rejection episode showed almost no uptake and only minimal secretion. The bile fraction appearing outside through the inserted T tube represented 94.6% ؎ 6.2% of the injected 99m Tc-BRIDA. We conclude that OLT results in markedly impaired hepatocellular uptake and biliary secretion of organic anions. Simultaneously, bile acid synthesis is significantly reduced, which, in addition, diminishes bile secretion of the graft. We show that T tube bile is a valid tool for bile physiological studies in patients in whom transplantation was successfully performed.

Hepatic Expression of ABC Transporters G5 and G8 Does Not Correlate With Biliary Cholesterol Secretion in Liver Transplant Patients *

“…Via this open biliary tube, bile flow was entirely diverted outside the patient into a collection bag that was placed below the horizontal bed level. 23 Interruption of the enterohepatic circulation in the patient was prevented through readministration of bile in the small intestine via a percutaneous feeding jejunostomy catheter. Samples of bile were collected daily in the first postoperative week, and were collected 3 times in the second week.…”

Rapid increase of bile salt secretion is associated with bile duct injury after human liver transplantation

“…Patients gave a written informed consent for the sampling of these tissue specimens. During transplantation a catheter was inserted in the common bile duct and daily bile production was completely diverted into a collecting bag [15]. To maintain the enterohepatic circulation of bile salts, bile was readministered to the patient via a jejunostomy catheter.…”

Expression of Heme Oxygenase‐1 in Human Livers Before Transplantation Correlates with Graft Injury and Function After Transplantation

“…During transplantation a bile drain was routinely placed into the common bile duct, allowing collection of bile (24). To avoid interruption of the enterohepatic circulation, bile was daily readministered via a jejunostomy catheter.…”