Liver Transplantation for Primary Sclerosing Cholangitis: A Long-Term Clinicopathologic Study

Urmila Khettry, Andrew Keaveny, Atoussa Goldar-Najafi, W. David Lewis, Elizabeth A. Pomfret, James J. Pomposelli, Roger L. Jenkins, Fredric D. Gordon

Research output: Contribution to journalArticle

99 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1127-1136
Number of pages10
JournalHuman Pathology
Volume34
Issue number11
DOIs
StatePublished - Nov 2003

Keywords

  • Autoimmune
  • Liver transplantation
  • Long-term
  • Sclerosing cholangitis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    Khettry, U., Keaveny, A., Goldar-Najafi, A., Lewis, W. D., Pomfret, E. A., Pomposelli, J. J., Jenkins, R. L., & Gordon, F. D. (2003). Liver Transplantation for Primary Sclerosing Cholangitis: A Long-Term Clinicopathologic Study. Human Pathology, 34(11), 1127-1136. https://doi.org/10.1053/j.humpath.2003.07.015