ABSTRACT
A widening gap between demand and availability of donor livers for transplantation has stimulated the use of extended-criteria donor(ECD)livers, including donation after circulatory death liver grafts.However, these types of donor livers carry an elevated risk of developing such postoperative complication as ischemic type biliary lesions(ITBL).Although the pathogenesis of ITBL has remained elusive, severity of histological bile duct injury(BDI)at the time of transplantation has been identified as a strong predictor of the development of ITBL post-transplantation.In recent years, significant advances have been achieved in the field of liver machine perfusion.Normothermic machine perfusion(NMP)is primarily utilized for determining the quality of ECD organs.To evaluate the extent of biliary injury during NMP, some reliable criteria of BDI are required.This review focused upon different approaches of assessing damage to biliary tree and current understandings of potential effects of NMP on biliary system and biliary injury.Also it offered an overview of novel biomarkers and emerging therapeutic strategies.