Junger, HenrikHenrikJungerMühlbauer, MarcoMarcoMühlbauerBrennfleck, Frank W.Frank W.BrennfleckSchurr, Leonhard A.Leonhard A.SchurrGoetz, MarkusMarkusGoetzEggenhofer, ElkeElkeEggenhoferKirchner, GabrieleGabrieleKirchnerEvert, KatjaKatjaEvertStefan Fichtner-FeiglGeissler, Edward KennethEdward KennethGeisslerSchlitt, Hans J.Hans J.SchlittBrunner, Stefan M.Stefan M.Brunner2023-04-182023-04-182023https://publica.fraunhofer.de/handle/publica/44031810.1111/ctr.14880Background: Early patient and allograft survival after liver transplantation (LT) depend primarily on parenchymal function, but long-term allograft success relies often on biliary-tree function. We examined parameters related to cholangiocyte damage that predict poor long-term LT outcomes after donation after brain death (DBD). Methods: Sixty bile ducts (BD) were assessed by a BD damage-score and divided into groups with "major" BD-damage (n = 33) and "no relevant" damage (n = 27) during static cold storage. Patients with "major" BD damage were further investigated by measuring biliary excretion parameters in the first 14 days post-LT (followed-up for 60-months). Results: Patients who received LT showing "major" BD damage had significantly worse long-term patient survival, versus grafts with "no relevant" damage (p = .03). When "major" BD damage developed, low bilirubin levels (p = .012) and high gamma-glutamyl transferase (GGT)/bilirubin ratio (p = .0003) were evident in the early post-LT phase (7-14 days) in patients who survived (> 60 months), compared to those who did not. "High risk" patients with bile duct damage and low GGT/bilirubin ratio had significantly shorter overall survival (p < .0001). Conclusions: Once "major" BD damage occurs, a high GGT/bilirubin ratio in the early post-operative phase is likely indicator of liver and cholangiocyte regeneration, and thus a harbinger of good overall outcomes. "Major" BD damage without markers of regeneration identifies LT patients that could benefit from future repair therapies.enjournal article