Abstract
Objective: Historically, bile in the biliary tract has been considered sterile. Most of the series are based on patients with biliary tract diseases or the bile has been obtained with procedures susceptible to contamination.Methods: We evaluated the bile in a heterogeneous cohort of liver donors and recipient patients, with samples obtained in a sterile way, directly from the gallbladder and the common bile duct.Results: We assessed the bile microbiota in six liver donors and in six liver recipients after whole or split liver procedures in adult or pediatric recipients. Bile samples were studied using PCR sequencing of the 16S ribosomal RNA gene amplification (rDNA).Conclusions: We demonstrated that the bile is sterile, thereby ruling this out as a source of contamination following transplant.
Highlights
The gallbladder has been considered a very hostile territory for bacteria
Donors with a history of gallstones or previous endoscopic retrograde cholangiopancreatography (ERCP) were excluded from the study, in order to avoid procedures or conditions associated with possible biliary contamination or bacterial translocation from gut to the biliary tree
We collected the following data: for donors, we evaluated age, gender, body mass index (BMI), cause of death, antibiotics therapy, intensive care unit (ICU) stay before the harvesting, cultural positivity, and type of graft; for recipients, we considered age, gender, model for end-stage liver disease (MELD), etiology of cirrhosis, cold and warm ischemia time, antibiotics therapy prior and after liver transplant (LT), cultural positivity, and hospital stay
Summary
Bile composition (bile acids, cholesterol, phospholipids, and the pigment biliverdin) functions as a biological detergent that emulsifies lipids. This property confers potent antimicrobial activity, primarily through the dissolution of bacterial membranes. For this reason, it has been assumed that the biliary tract is sterile in healthy individuals. Recent studies reported the presence of bacteria in other regions until now considered sterile including but not limited to (a) the female reproductive tract and (b) the urinary and respiratory tract [1, 2]. Bile compositions have been evaluated in patients with acute cholangitis and cholecystitis and recently in patients with distal cholangiocarcinoma [3].
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