PMC5686042_01
Liver graft with an accidently ligated common bile duct, leaving the biliary tree and the gallbladder completely unflushed during the cold preservation.
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In addition, the gallbladder was not opened nor flushed (Fig. 1), leaving the graft with stagnating bile for at least 4 h 38 min.
Endoscopic-retrograde-cholangio-pancreaticography at 2 months post liver transplantation reveals mainly diffuse filiform intra-hepatic biliary ducts with multiple narrowings ("dead tree" image) typical of NAS and the aspect of a local ischemia at the site of the biliary anastomosis.
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Endoscopic-retrograde-cholangio-pancreaticography revealed filiform intra-hepatic biliary ducts with multiple narrowings ("dead tree" image) typical of NAS (Fig. 2) and the aspect of a local ischemia at the site of the biliary anastomosis.
CT with IV contrast, one month after transplantation, showing a patent hepatic artery.
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Hepatic artery occlusion or stenosis were excluded by repeated echo doppler examinations and CT scan (Fig. 3).
Microscopic section of the explanted transplant liver showing extensive scarring and necrosis of the bile ducts (left) and early onset of biliary cirrhosis (right, Sirius red staining).
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Microscopic analysis of the explanted liver confirmed the extensive scarring and necrosis of the bile ducts and early onset of biliary cirrhosis (Fig. 4).