TY - JOUR
T1 - Liver Transplantation for Primary Sclerosing Cholangitis
T2 - A Long-Term Clinicopathologic Study
AU - Khettry, Urmila
AU - Keaveny, Andrew
AU - Goldar-Najafi, Atoussa
AU - Lewis, W. David
AU - Pomfret, Elizabeth A.
AU - Pomposelli, James J.
AU - Jenkins, Roger L.
AU - Gordon, Fredric D.
PY - 2003/11
Y1 - 2003/11
N2 - The course and outcome of patients after liver transplantation (LT) for primary sclerosing cholangitis (PSC) are still debated. Our purpose is to define retrospectively, the post-LT clinicopathologic findings seen in 51 PSC patients with a follow-up of 2 to 14 years. Of the total 51 patients, 16 with native liver hilar xanthogranulomatous cholangiopathy (XGC) had median graft and patient survival of 573 and 835 days, respectively compared with 2489 and 2794 days, respectively, in 35 patients without XGC. Perioperative complications resulted in 9 early deaths (day 0 to 52). Of the remaining 42 patients, 6 had recurrent PSC (R-PSC) with typical histologic and cholangiographic findings, 12 had autoimmune liver disease-not otherwise specified with histology of autoimmune hepatitis/overlap syndrome, 3 had chronic rejection, 4 had ischemic cholangiopathy, and 17 had no recurrence. The presence of inflammatory bowel disease, total ischemia time of ≥11 hours, recipient-donor ABO and HLA Class I and II matches, and the type of immunosuppression did not affect the post-LT outcome. Recipient-donor gender mismatch was more common in R-PSC than in the nonrecurrent group (P = 0.045). Post-LT malignancies were significantly more common in the nonrecurrent cases compared with all others combined (P = 0.031) and caused deaths in 4. The majority of deaths (11/13) in other groups were due to sepsis complicating graft dysfunction. In conclusion, allograft autoimmune liver disease was seen in 18 (43%) of 42 long-term post-LT PSC patients, with progression in 5 of 18 patients. Features of PSC were seen in 6 (33%) of 18. Native liver XGC negatively impacted post-LT graft and patient survival. Increased incidence of malignancies in the nonrecurrent group may reflect overimmunosuppression in those patients.
AB - The course and outcome of patients after liver transplantation (LT) for primary sclerosing cholangitis (PSC) are still debated. Our purpose is to define retrospectively, the post-LT clinicopathologic findings seen in 51 PSC patients with a follow-up of 2 to 14 years. Of the total 51 patients, 16 with native liver hilar xanthogranulomatous cholangiopathy (XGC) had median graft and patient survival of 573 and 835 days, respectively compared with 2489 and 2794 days, respectively, in 35 patients without XGC. Perioperative complications resulted in 9 early deaths (day 0 to 52). Of the remaining 42 patients, 6 had recurrent PSC (R-PSC) with typical histologic and cholangiographic findings, 12 had autoimmune liver disease-not otherwise specified with histology of autoimmune hepatitis/overlap syndrome, 3 had chronic rejection, 4 had ischemic cholangiopathy, and 17 had no recurrence. The presence of inflammatory bowel disease, total ischemia time of ≥11 hours, recipient-donor ABO and HLA Class I and II matches, and the type of immunosuppression did not affect the post-LT outcome. Recipient-donor gender mismatch was more common in R-PSC than in the nonrecurrent group (P = 0.045). Post-LT malignancies were significantly more common in the nonrecurrent cases compared with all others combined (P = 0.031) and caused deaths in 4. The majority of deaths (11/13) in other groups were due to sepsis complicating graft dysfunction. In conclusion, allograft autoimmune liver disease was seen in 18 (43%) of 42 long-term post-LT PSC patients, with progression in 5 of 18 patients. Features of PSC were seen in 6 (33%) of 18. Native liver XGC negatively impacted post-LT graft and patient survival. Increased incidence of malignancies in the nonrecurrent group may reflect overimmunosuppression in those patients.
KW - Autoimmune
KW - Liver transplantation
KW - Long-term
KW - Sclerosing cholangitis
UR - http://www.scopus.com/inward/record.url?scp=0345017694&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0345017694&partnerID=8YFLogxK
U2 - 10.1053/j.humpath.2003.07.015
DO - 10.1053/j.humpath.2003.07.015
M3 - Article
C2 - 14652814
AN - SCOPUS:0345017694
SN - 0046-8177
VL - 34
SP - 1127
EP - 1136
JO - Human Pathology
JF - Human Pathology
IS - 11
ER -