Pascale MM, Gervasoni J, Bianco G, Persichilli S, Ferri L, Primiano A, Agnes S, Urbani A. Graft bile analysis for predicting post-transplant outcomes: A literature review and a protocol for a novel biomarker. World J Gastrointest Surg 2026; 18(1): 114662 [DOI: 10.4240/wjgs.v18.i1.114662]
Corresponding Author of This Article
Marco Maria Pascale, MD, General Surgery and Organ Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 8 Largo A Gemelli, Rome 00168, Lazio, Italy. marcomaria.pascale@policlinicogemelli.it
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 28, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Pascale MM, Gervasoni J, Bianco G, Persichilli S, Ferri L, Primiano A, Agnes S, Urbani A. Graft bile analysis for predicting post-transplant outcomes: A literature review and a protocol for a novel biomarker. World J Gastrointest Surg 2026; 18(1): 114662 [DOI: 10.4240/wjgs.v18.i1.114662]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114662 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114662
Graft bile analysis for predicting post-transplant outcomes: A literature review and a protocol for a novel biomarker
Marco Maria Pascale, Jacopo Gervasoni, Giuseppe Bianco, Silvia Persichilli, Lorenzo Ferri, Aniello Primiano, Salvatore Agnes, Andrea Urbani
Marco Maria Pascale, Giuseppe Bianco, Salvatore Agnes, General Surgery and Organ Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Lazio, Italy
Lorenzo Ferri, General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Lazio, Italy
Salvatore Agnes, Andrea Urbani, Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome 00168, Lazio, Italy
Co-first authors: Marco Maria Pascale and Jacopo Gervasoni.
Author contributions: Pascale MM and Gervasoni J contributed equally as co-first authors; Pascale MM, Gervasoni J, and Bianco G contributed to conceptualization; Pascale MM contributed to methodology, data curation, funding acquisition, and writing the original draft; Persichilli S performed the validation; Primiano A performed the formal analysis; Ferri L contributed to resources; Agnes S and Urbani A supervised and reviewed and edited the draft; All authors read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Maria Pascale, MD, General Surgery and Organ Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 8 Largo A Gemelli, Rome 00168, Lazio, Italy. marcomaria.pascale@policlinicogemelli.it
Received: September 25, 2025 Revised: November 15, 2025 Accepted: December 24, 2025 Published online: January 27, 2026 Processing time: 118 Days and 18.5 Hours
Core Tip
Core Tip: Early detection of graft dysfunction and rejection after liver transplantation remains challenging. This minireview highlighted bile as an organ-specific biofluid directly reflecting hepatocellular and cholangiocyte function. We summarized the biochemical, metabolic, and molecular components of bile as predictive markers of graft viability during machine perfusion and in the perioperative period. Building on these insights, we presented a prospective protocol assessing biliary tacrolimus concentration and introducing the blood-bile ratio of tacrolimus as a novel index for early, noninvasive detection of rejection. Integrating bile biomarkers into transplant workflows may enable real-time, graft-specific monitoring and improve post-transplant outcomes.
