Long-term results of patients undergoing liver... : Hepatology (original) (raw)

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Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis

Graziadei, Ivo W.1; Wiesner, Russell H. M.D.*,1; Marotta, Paul J.1; Porayko, Michael K.1; Hay, Eileen J.1; Charlton, Michael R.1; Poterucha, John J.1; Rosen, Charles B.1; Gores, Gregory J.1; LaRusso, Nicholas F.1; Krom, Ruud A. F.1

1From the Liver Transplant Unit, Mayo Clinic, Rochester, MN

E-mail: [email protected]

*Address reprint requests to: Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 fax: 507-266-1856

Received May 30, 1999; accepted August 17, 1999; previously published online December 30, 2003

Abstract

Liver transplantation is the only effective therapeutic option for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC). In this study, we analyzed a single center's experience with 150 consecutive PSC patients who received 174 liver allografts. Mean follow-up was 55 months. Actuarial patient survival at 1, 2, 5, and 10 years was 93.7%, 92.2%, 86.4%, and 69.8%, respectively, whereas graft survival was 83.4%, 83.4%, 79.0%, and 60.5%, respectively. The main indication for retransplantation was hepatic artery thrombosis, and the major cause of death was severe infection. Patients with PSC had a higher incidence of acute cellular and chronic ductopenic rejection compared to a non-PSC control group. Chronic ductopenic rejection adversely affected patient and graft survival. Biliary strictures, both anastomotic and nonanastomotic, were frequent and occurred in 16.2% and 27.2% of patients, respectively. The incidence of recurrent PSC was 20%. A negative impact on patient survival was not seen in patients with either postoperative biliary strictures or recurrence of PSC. Six patients (4%) had cholangiocarcinoma and 1 patient died related to recurrence of malignant disease. Seventy-eight percent of PSC patients had associated inflammatory bowel disease, most commonly chronic ulcerative colitis, which did not adversely impact patient outcome posttransplantation. Nine patients required proctocolectomy after liver transplantation; 5 because of intractable symptoms related to inflammatory bowel disease and 4 due to the development of colorectal carcinoma/high-grade dysplasia. Our data show that liver transplantation provides excellent long-term patient and graft survival for patients with end-stage PSC.