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

Table 1

Pathomechanisms leading to ITBLs after liver transplantation.

Type of injury
Ischemia reperfusion related
(i) Warm ischemia in the donor
(ii) Prolonged cold ischemia time
(iii) Reperfusion injury
(iv) High viscosity of cold preservation solutions
(v) Warm ischemia during graft implantation
(vi) Microcirculatory disturbances in the peribiliary capillary plexus
Bile salts related
(i) Cytoprotective hydrophilic bile salts (decreased after liver transplantation)
(ii) Cytotoxic hydrophobic bile salts (accumulated after liver transplantation)
Insufficient flush out of bile from the bile ducts during liver transplantation
High biliary bile salt/phospholipid ratio after liver transplantation
Impaired vectorial bile duct secretion with intracellular accumulation of bile salts in cholangiocytes
Impaired biliary secretion of the protecting cholangiocyte factor HCO3(−)
Immune mediated
(i) ABO-incompatible liver transplantation
(ii) Acute rejection
(iii) Chronic rejection
(iv) Gender (female liver transplanted in male recipient)
(v) Cytomegalovirus (CMV) infection in the graft
(vi) Chemokine polymorphism in graft recipients (CC receptor 5 delta 32)
(vii) Preexisting autoimmune disease of the graft
Primary sclerosing cholangitis
Autoimmune hepatitis
(viii) Metalloproteinase (MMP) polymorphism in donor and recipient graft
MM P-2 genotype polymorphism