Recurrence of Primary Sclerosing Cholangitis Following Liver Transplantation

Abstract

Recurrence of primary sclerosing cholangitis (PSC) following liver transplantation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. In the present study, we investigated the recurrence of PSC by developing strict criteria and applying them to a large cohort of PSC patients who underwent liver transplantation. Between March 1985 and June 1996, 150 PSC patients underwent liver transplantation at the Mayo Clinic; mean follow up was 55 months. The incidence of nonanastomotic biliary strictures and hepatic histologic findings suggestive of PSC were compared between patients transplanted for PSC and a non-PSC transplant control group. Our definition of recurrent PSC was based on characteristic cholangiographic and histologic findings that occur in nontransplant PSC patients. By using strict criteria, 30 patients with other known causes of posttransplant nonanastomotic biliary strictures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 patients (20%). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologic abnormalities with a mean time to diagnosis of 360 and 1,350 days, respectively. Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later onset of nonanastomotic biliary strictures in patients with PSC compared with a non-PSC control group is supportive of the fact that PSC does recur following liver transplantation. We were unable to identify specific clinical risk factors for recurrent PSC, and the overall patient and graft survival in patients with recurrent PSC was similar to those without evidence of recurrence. Our observations provide convincing evidence that PSC frequently recurs in the hepatic allograft using strict inclusion and exclusion criteria. (HEPATOLOGY

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

“…Similarly, histopathologic characteristics of PSC recurrence can be similar to CR. 40,41 In the present series, we observed the development of CR in 3.7% of patients (3 of 81 patients) with a primary diagnosis of PSC.…”

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

“…This is similar to a recurrence rate of 20% reported in adults. 25 In summary, our study showed that children with PSC have a significantly shorter survival than that expected in age-and gender-matched general population. PSC follows a progressive course in children, with many patients requiring liver transplantation, but PSC may recur in the allograft.…”

Retransplantation for hepatic allograft failure: Prognostic modeling and ethical considerations

“…lO Although recurrence of PBC and PSC was initially the source of much debate, numerous studies subsequently have described its occurrence and natural hist 0 r y .~~,~3 A recent analysis from the Mayo Clinic found evidence of PSC recurrence in 20% of liver transplant recipients. 24 In another report, 13 of 83 liver transplant recipients with PBC developed allograft findings consistent with PBC versus none of 105 patients who underwent transplantation for causes other than PBC. 25 In each series, a small proportion (<5%) ultimately developed graft failure caused by recurrent PBC or PSC.…”