Studies on bile duct Injury and the protective role of oxygenated machine perfusion in liver transplantation

Bile duct complications, and most importantly non-anastomotic biliary complications (NAS), remain to be a major limiting factor after liver transplantation. Non-anastomotic biliary complications usually occur due to multifocal strictures at intrahepatic or extrahepatic bile ducts and patients present with features of biliary obstruction. In this thesis, we aimed to obtain a better understanding of the origin of bile duct injuries and the potential underlying etiologies that lead to NAS after liver transplantation. Moreover, we investigated the role of oxygenated machine perfusion in improving the quality of organ before transplantation to potentially reduce the development of post-transplantation complications including NAS. In summary, the studies described in this thesis have provided a better understanding of the underlying pathophysiology of bile duct injuries during and after transplantation; Approaches to improve the quality of organ prior to transplantation, prevention of bile duct injuries during organ preservation and a better organ selection for transplantation have been discussed. Moreover, the safety and feasibility of dual hypothermic oxygenated machine perfusion (DHOPE) of DCD liver grafts prior to transplantation has been reported. I hope that the technique of machine perfusion will be used extensively in clinical practice to increase the number of suitable organs for transplantation and expand global access to such a life-saving therapy.