Recurrence of cholestatic liver disease after living donor liver transplantation

Abstract

End-stage liver disease, due to cholestatic liver diseases with an autoimmune background such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), is considered a good indication for liver transplantation. Excellent overall patient and graft outcomes, based mostly on the experience from deceased donor liver transplantation (DDLT), have been reported. Due to the limited number of organ donations from deceased donors in most Asian countries, living donor liver transplantation (LDLT) is the mainstream treatment for end-stage liver disease, including that resulting from PBC and PSC. Although the initial experiences with LDLT for PBC and PSC seem satisfactory or comparable to that with DDLT, some aspects, including the timing of transplantation, the risk of recurrent disease, and its long-term clinical implications, require further evaluation. Whether or not the long-term outcomes of LDLT from a biologically related donor are equivalent to that of DDLT requires further observations. The clinical course following LDLT may be affected by the genetic background shared between the recipient and the living related donor.

Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation

“…Primary biliary cirrhosis (PBC), PSC and AIH may all recur after liver transplantation and diagnostic criteria for recurrence may differ from the ones used for similar native liver disease 71 72 73 74 75. Recurrence of alcoholic liver disease, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis have also been reported 1 30 76 77 78.…”

Living Donor and Deceased Donor Liver Transplantation for Autoimmune and Cholestatic Liver Diseases—An Analysis of the UNOS Database

“…2 Recently, several retrospective reviews on LT for AIH and other cholestatic liver diseases have emerged from various transplant programs. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] There are no comparisons of the long-term outcome of patients undergoing LT for each of these autoimmune diseases, and no comparative data for living donor liver transplants (LDLT) vs. deceased donor liver transplants (DDLT) for these conditions.…”

Live donor liver transplantation for primary sclerosing cholangitis: is disease recurrence increased?

“…The first case of suspected PSC recurrence after LDLT was described by Kita et al [11] Tamura et al [9] in 2008). None of them reported on PSC recurrence, mainly due to lack of numbers and long-term outcome of PSC patients treated with LDLT.…”

“…This might be explained by the rare incidence of PSC in the far east where LDLT is far more common than DDLT compared with western countries. End-stage liver disease secondary to PSC accounts for less than 2-3% of the total number of liver transplantations performed in Japan [9].…”