Recurrence and rejection in liver transplantation for primary sclerosing cholangitis - PubMed (original) (raw)

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Recurrence and rejection in liver transplantation for primary sclerosing cholangitis

Bjarte Fosby et al. World J Gastroenterol. 2012.

Abstract

Primary sclerosing cholangitis (PSC) is a chronic progressive inflammatory disease affecting the bile ducts, leading to fibrosis and eventually cirrhosis in most patients. Its etiology is unknown and so far no effective medical therapy is available. Liver transplantation (LTX) is the only curative treatment and at present PSC is the main indication for LTX in the Scandinavian countries. Close to half of the PSC patients experience one or more episodes of acute cellular rejection (ACR) following transplantation and approximately 1/5 of the transplanted patients develop recurrent disease in the graft. In addition, some reports indicate that ACR early after LTX for PSC can influence the risk for recurrent disease. For these important post-transplantation entities affecting PSC patients, we have reviewed the current literature on epidemiology, pathogenesis, treatment and the possible influence of rejection on the risk of recurrent disease in the allograft.

Keywords: Liver transplantation; Primary sclerosing cholangitis; Recurrence; Rejection.

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Figures

Figure 1

Figure 1

Endoscopic retrograde cholangiogram in a patient with recurrent primary sclerosing cholangitis, showing multifocal stenosis with intervening saccular dilatations affecting both intrahepatic and extrahepatic bile ducts.

Figure 2

Figure 2

Histological changes demonstrated in a biopsy from a patient with recurrent primary sclerosing cholangitis. Bile duct (small arrow) surrounded by collar of connective tissue with concentric layers of collagen fibers (large arrow) illustrating the typical periductal lamellar fibrosis. (Original magnification, x 100).

Figure 3

Figure 3

Histological changes seen in a biopsy with acute cellular rejection in a patient with primary sclerosing cholangitis. Portal tract with mixed inflammatory infiltrate containing blastic lymphocytes and eosinophils. Subendothelial localization of the inflammatory cells in a portal vein branch (small arrow). Inflammation of small bile duct (large arrow). (Original magnification, x 400).

References

    1. Farrant JM, Hayllar KM, Wilkinson ML, Karani J, Portmann BC, Westaby D, Williams R. Natural history and prognostic variables in primary sclerosing cholangitis. Gastroenterology. 1991;100:1710–1717. - PubMed
    1. Tischendorf JJ, Hecker H, Krüger M, Manns MP, Meier PN. Characterization, outcome, and prognosis in 273 patients with primary sclerosing cholangitis: A single center study. Am J Gastroenterol. 2007;102:107–114. - PubMed
    1. Miki C, Harrison JD, Gunson BK, Buckels JA, McMaster P, Mayer AD. Inflammatory bowel disease in primary sclerosing cholangitis: an analysis of patients undergoing liver transplantation. Br J Surg. 1995;82:1114–1117. - PubMed
    1. Shorbagi A, Bayraktar Y. Primary sclerosing cholangitis--what is the difference between east and west? World J Gastroenterol. 2008;14:3974–3981. - PMC - PubMed
    1. Aadland E, Schrumpf E, Fausa O, Elgjo K, Heilo A, Aakhus T, Gjone E. Primary sclerosing cholangitis: a long-term follow-up study. Scand J Gastroenterol. 1987;22:655–664. - PubMed

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