Recurrence of Primary Sclerosing Cholangitis in Patients After Liver Transplantation

Ołdakowska‐Jedynak, Urszula; Nowak, Magdalena; Mucha, Krzysztof; Foroncewicz, Bartosz; Nyckowski, P; Zieniewicz, Krzysztof; Ziarkiewicz‐Wróblewska, Bogna; Patkowski, Waldemar; Górnicka, Barbara; Paczkowska, A; Michałowicz, B; Pilecki, Tomasz; Pawlak, Jacek; Krawczyk, Marek; Pączek, Leszek

doi:10.1016/j.transproceed.2005.12.026

Cited by 14 publications

(6 citation statements)

References 10 publications

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“…Magnetic resonance cholangiography showed the presence of bile duct strictures suggestive of recurrence in 9 cases and 1 control. Oldakowska‐Jedynak et al52 also reported PSC recurrence on the basis of magnetic resonance cholangiography findings in 2 patients in their cohort.…”

Section: Discussionmentioning

confidence: 82%

“…Thirty publications on PSC recurrence were identified (Table 2). To determine the rate of PSC recurrence after liver transplantation, 14 reports that emanated from original studies (all positive) were used 16, 17, 19, 30, 31, 44–52. Four other identified publications were excluded because their study cohorts were duplicated in later studies 12, 53–55.…”

Section: Resultsmentioning

confidence: 99%

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Recurrence of autoimmune liver disease after liver transplantation: A systematic review

2006

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Recurrence of autoimmune liver disease in allografts has long been a topic of debate. We conducted a systematic review of the literature to examine the reported incidence of recurrence after liver transplantation of primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH). The MEDLINE, EMBASE, and Cochrane electronic databases were used to identify articles. The inclusion criteria used were articles on patients with at least 90 days of posttransplantation follow-up, histologic criteria for diagnosis of PBC and AIH recurrence, radiologic or histologic criteria or both for diagnosis of PSC recurrence, and exclusion of other causes of liver disease causing similar histologic findings. Incidence in individual studies was combined to calculate the overall recurrence. Risk factors were analyzed whenever crude data were available. Funnel plots were used to assess publication bias. Out of 90 articles identified, 43 met criteria for systematic review (PBC, 16; PSC, 14; AIH, 13). The calculated weighted recurrence rate was 18% for PBC, 11% for PSC, and 22% for AIH. No difference was found in PBC and AIH recurrence by type of primary immunosuppression. There were not enough data to assess this issue in PSC studies. There was evidence of publication bias among PSC and AIH studies but not among PBC studies. In conclusion, recurrence of autoimmune liver disease after liver transplantation appears to be a real concern. As these patients are followed long-term, recurrence of disease may become the primary cause of morbidity.

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Section: Discussionmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Recurrence of autoimmune liver disease after liver transplantation: A systematic review

2006

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“…Another issue is the differences in exclusion/inclusion criteria and methods of diagnosis, which we feel are the reason for the discrepancies among studies of the incidence and the risk factors associated with rPSC 7, 17–19, 24. In some studies,25 the diagnosis of rPSC was based only on histological findings, but it is known that liver biopsy is inaccurate for the diagnosis of PSC due to sampling problems.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrence of primary sclerosing cholangitis after liver transplantation

et al. 2008

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Liver transplantation (LT) is the only therapeutic option for end-stage primary sclerosing cholangitis (PSC), but PSC can recur (rPSC) in some patients after LT. The aim of our study was to evaluate the risk factors associated with rPSC. Between 1989 and 2004, 69 patients receiving transplantation for PSC (42 male, mean age 41.9 yr). Clinical and laboratory data, activity/extension and treatment of ulcerative colitis (UC), post-LT cytomegalovirus (CMV) infection, and immunosuppression were evaluated. Determination of rPSC was made by radiological and histological findings. Exclusion criteria were ABO blood group incompatibility, hepatic artery stenosis, and biliary strictures occurring in Ͻ3 months post-LT. A total of 48 (70%) patients had PSC and UC pre-LT. rPSC occurred in 7 of 53 (13.5%, 2 patients with de novo UC) who were alive 1 yr after LT and/or met inclusion/exclusion criteria: median 60 (4-120) months. No patient without post-LT UC had rPSC: 0 of 20 vs. 7 of 26 with post-LT UC (P ϭ 0.027). The multivariate logistic regression analysis showed that maintenance steroids for UC (Ͼ3 months) post-LT was the only risk factor significantly associated with rPSC (P ϭ 0.025). In conclusion, the presence of UC post-LT, and the need for maintenance steroids post-LT, which is an independent factor, are associated with rPSC. These findings could help elucidate a possible mechanism of PSC pathogenesis.

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“…A higher incidence of acute and chronic and steroid-resistant rejection in PSC patients has been reported, especially in the presence of coexistent inflammatory bowel disease 49 62. Recurrence of PSC after transplantation ranges from 9% to 47% 62 63 70 71 74 133 134 135 136 137 138 139. Risk factors for disease recurrence include donor–recipient gender mismatch, male gender, and intact colon at the time of transplantation 49 140.…”

Section: Disease Recurrencementioning

confidence: 99%

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

2009

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The spectrum of diseases encountered in post-transplant liver pathology biopsies is broad. In this review, these have been divided as belonging to one of three categories: (1) new-onset/de novo post-transplant abnormalities (early and late), (2) rejection, and (3) recurrence of original disease. The clinical and pathological features of the entities making up each category, with the relevant differential diagnosis and overlaps between and within these groups, are discussed and illustrated. Recurrent or de novo neoplasms make up a fourth category not included in this review. Early new-onset conditions are mostly related to surgical complications, donor factors and ischaemia to the graft. These include reperfusion/preservation injury, lipopeliosis, small-for-size-syndrome, biliary sludge syndrome and hepatic artery thrombosis. The various forms of rejection (cellular, chronic, antibody-mediated, and late atypical rejection) are detailed. Most chronic liver diseases can and do recur in the graft. They may display features that overlap with de novo conditions (eg, primary sclerosing cholangitis versus chronic rejection). As with most cases of allograft biopsy interpretation, accurate diagnosis rests with careful correlation of histological features with clinical, imaging and laboratory findings, and often comparison with previous sequential and follow-up biopsies. Late-onset new diseases include biliary strictures, idiopathic chronic hepatitis and de novo autoimmune hepatitis, among others. This review provides a practical approach to the interpretation of these challenging biopsies. Selected difficult scenarios or conundrums are identified and discussed in the relevant sections.

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Recurrence of Primary Sclerosing Cholangitis in Patients After Liver Transplantation

Cited by 14 publications

References 10 publications

Recurrence of autoimmune liver disease after liver transplantation: A systematic review

Recurrence of autoimmune liver disease after liver transplantation: A systematic review

Risk factors for recurrence of primary sclerosing cholangitis after liver transplantation

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

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