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Clinically recurrent primary sclerosing cholangitis following liver transplantation: a time course. Liver Transpl 2008 Feb;14(2):181-5

Date

02/01/2008

Pubmed ID

18236392

DOI

10.1002/lt.21313

Scopus ID

2-s2.0-39449110708   113 Citations

Abstract

Orthotopic liver transplantation (OLT) is the treatment of choice for patients with end-stage primary sclerosing cholangitis (PSC). This study sought to chronicle the natural history of PSC recurrence following OLT and identify clinical variables that may contribute to disease reemergence. From 1988 to 2006, 1102 OLTs were performed in 1032 adults at the University of Colorado Health Sciences Center. Of these, 130 patients (12.6%) with PSC received 146 allografts. Recurrence was defined by a clinically worsening examination and radiographic evidence. A total of 9 potential predictors were considered, using both bivariate log rank and multivariate Cox analysis, including: age > 55, gender, surgical technique (piggyback technique), presence of inflammatory bowel disease, intact colon before transplant, or cholangiocarcinoma (CCA), cold ischemia time, sirolimus-based immunosuppression, and graft type. The 1, 5, and 10-year recurrence-free survival was 91%, 76%, and 61%, respectively. The crude incidence of disease recurrence was 22 of 130 patients or 16.9%. Patients' risk of recurrent PSC at 1, 5, and 10 years was 2%, 12%, and 20%, respectively (mortality censored). Of the 22 patients that developed recurrent disease, 7 received a second transplant. Of the 9 factors considered, the presence of CCA prior to OLT is significantly predictive of disease recurrence [risk ratio (RR) = 3.77; P = 0.0038]. Once a patient was diagnosed with recurrent disease, the median survival without receiving a second transplant was 39.1 months (95% confidence interval: 27.6-50.6 months). In conclusion, recurrent PSC following OLT is a formidable but protracted problem following OLT. Patients may require a second transplant following reemergent disease with reasonable survival benefit.

Author List

Campsen J, Zimmerman MA, Trotter JF, Wachs M, Bak T, Steinberg T, Kam I

Author

Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Cholangitis, Sclerosing
Colorado
Disease-Free Survival
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Liver Transplantation
Male
Middle Aged
Proportional Hazards Models
Recurrence
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0