Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis

Abstract

Liver transplantation is the only effective therapeutic option for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC). In this study, we analyzed a single center's experience with 150 consecutive PSC patients who received 174 liver allografts. Mean follow-up was 55 months. Actuarial patient survival at 1, 2, 5, and 10 years was 93.7%, 92.2%, 86.4%, and 69.8%, respectively, whereas graft survival was 83.4%, 83.4%, 79.0%, and 60. 5%, respectively. The main indication for retransplantation was hepatic artery thrombosis, and the major cause of death was severe infection. Patients with PSC had a higher incidence of acute cellular and chronic ductopenic rejection compared to a non-PSC control group. Chronic ductopenic rejection adversely affected patient and graft survival. Biliary strictures, both anastomotic and nonanastomotic, were frequent and occurred in 16.2% and 27.2% of patients, respectively. The incidence of recurrent PSC was 20%. A negative impact on patient survival was not seen in patients with either postoperative biliary strictures or recurrence of PSC. Six patients (4%) had cholangiocarcinoma and 1 patient died related to recurrence of malignant disease. Seventy-eight percent of PSC patients had associated inflammatory bowel disease, most commonly chronic ulcerative colitis, which did not adversely impact patient outcome posttransplantation. Nine patients required proctocolectomy after liver transplantation; 5 because of intractable symptoms related to inflammatory bowel disease and 4 due to the development of colorectal carcinoma/high-grade dysplasia. Our data show that liver transplantation provides excellent long-term patient and graft survival for patients with end-stage PSC.

Liver biopsy interpretation for causes of late liver allograft dysfunction

“…However, a thorough clinicopathological correlation is needed to distinguish among many underlying causes, such as recurrent PSC, ischemic cholangitis due to injury from prolonged preservation or non-heart-beating donors, imperfect biliary anastomoses, inadequate arterial flow, and antibody-mediated rejection. 4,[88][89][90][91][92] Periportal hepatocyte copper deposition signals chronic bile flow impediments.…”

Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature

“…Additional experience with LT for CCC was obtained by reviewing the literature related to LT for PSC. 27,[38][39][40][41][42] This series represents the fourth largest single-center series published on the use of LT for the treatment of unresectable CCC. In the combined single-center experience, the 3-year patient survival rate is between 10% and 53%.…”

Primary Sclerosing Cholangitis in Children: A Long–Term Follow–Up Study

“…2 Liver transplantation remains the only life-extending therapeutic alternative for patients with end-stage PSC. 3 PSC represents one of the most common chronic cholestatic liver diseases diagnosed in the adult population. In children and adolescents, however, the increased awareness of this condition along with a widespread use of invasive cholangiography (i.e., endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography) have led to increased frequency of diagnosis.…”