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. 2023 Oct 27;12(21):6793.
doi: 10.3390/jcm12216793.

Histological Assessment of the Bile Duct before Liver Transplantation: Does the Bile Duct Injury Score Predict Biliary Strictures?

Mark Ly  1   2 , Ngee-Soon Lau  1   2 , Catriona McKenzie  2   3 , James G Kench  2   3 , Doruk Seyfi  1   2 , Avik Majumdar  1   2 , Ken Liu  1   2   4 , Geoffrey McCaughan  1   2   4 , Michael Crawford  1   2 , Carlo Pulitano  1   2
Affiliations

Histological Assessment of the Bile Duct before Liver Transplantation: Does the Bile Duct Injury Score Predict Biliary Strictures?

Mark Ly et al. J Clin Med. .

Abstract

Introduction: Histological injury to the biliary tree during organ preservation leads to biliary strictures after liver transplantation. The Bile Duct Injury (BDI) score was developed to assess histological injury and identify the grafts most likely to develop biliary strictures. The BDI score evaluates the bile duct mural stroma, peribiliary vascular plexus (PVP) and deep peribiliary glands (DPGs), which were correlated with post-transplant biliary strictures. However, the BDI score has not been externally validated. The aim of this study was to verify whether the BDI score could predict biliary strictures at our transplant centre.

Methods: Brain-dead donor liver grafts transplanted at a single institution from March 2015 to June 2016 were included in this analysis. Bile duct biopsies were collected immediately before transplantation and assessed for bile duct injury by two blinded pathologists. The primary outcome was the development of clinically significant biliary strictures within 24 months post-transplant.

Results: Fifty-seven grafts were included in the study which included 16 biliary strictures (28%). Using the BDI score, mural stromal, PVP and DPG injury did not correlate with biliary strictures including Non-Anastomotic Strictures. Severe inflammation (>50 leucocytes per HPF) was the only histological feature inversely correlated with the primary outcome (absent in the biliary stricture group vs. 41% in the no-stricture group, p = 0.001).

Conclusions: The current study highlights limitations of the histological assessment of bile duct injury. Although all grafts had bile duct injury, only inflammation was associated with biliary strictures. The BDI score was unable to predict post-transplant biliary strictures in our patient population.

Keywords: bile duct injury; biliary complications; liver transplantation; organ donation; organ preservation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Illustrations of mild and severe injury according to components of the bile duct injury score (mural stroma, peribiliary vascular plexus and deep peribiliary gland). Magnification is provided per illustration.
Figure 2
Figure 2
(A) Biopsy demonstrating severe mural stromal injury at ×200 magnification. (B) Severe inflammation at ×400 magnification. Rates of severe (C) mural stromal injury, (D) peribiliary vascular plexus injury, (E) deep peribiliary gland injury and (F) inflammation according to development of biliary strictures.
Figure 3
Figure 3
The incidence of severe injury to the (A) biliary epithelium, (B) mural stroma, (C) vascular plexus and (D) deep peribiliary glands according to development of Non-Anastomotic Strictures.
See this image and copyright information in PMC

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