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

Ivo W. Graziadei, Russell H. Wiesner, Paul J. Marotta, Michael K. Porayko, J. Eileen Hay, Michael R. Charlton, John J. Poterucha, Charles B. Rosen, Gregory James Gores, Nicholas F La Russo, Ruud A F Krom

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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 procto-colectomy after liver transplantation; 5 because of intractable symptoms related to inflammatory bowel disease and 4 due to the development of colorectal carcinoma/highgrade dysplasia. Our data show that liver transplantation provides excellent long- term patient and graft survival for patients with end-stage PSC.

Original languageEnglish (US)
Pages (from-to)1121-1127
Number of pages7
JournalHepatology
Volume30
Issue number5
DOIs
StatePublished - 1999

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Sclerosing Cholangitis
Liver Transplantation
Graft Survival
Pathologic Constriction
Recurrence
End Stage Liver Disease
Survival
Cholangiocarcinoma
Colectomy
Hepatic Artery
Incidence
Ulcerative Colitis
Inflammatory Bowel Diseases

ASJC Scopus subject areas

  • Hepatology

Cite this

Graziadei, I. W., Wiesner, R. H., Marotta, P. J., Porayko, M. K., Eileen Hay, J., Charlton, M. R., ... Krom, R. A. F. (1999). Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. Hepatology, 30(5), 1121-1127. https://doi.org/10.1002/hep.510300501

Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. / Graziadei, Ivo W.; Wiesner, Russell H.; Marotta, Paul J.; Porayko, Michael K.; Eileen Hay, J.; Charlton, Michael R.; Poterucha, John J.; Rosen, Charles B.; Gores, Gregory James; La Russo, Nicholas F; Krom, Ruud A F.

In: Hepatology, Vol. 30, No. 5, 1999, p. 1121-1127.

Research output: Contribution to journalArticle

Graziadei, IW, Wiesner, RH, Marotta, PJ, Porayko, MK, Eileen Hay, J, Charlton, MR, Poterucha, JJ, Rosen, CB, Gores, GJ, La Russo, NF & Krom, RAF 1999, 'Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis', Hepatology, vol. 30, no. 5, pp. 1121-1127. https://doi.org/10.1002/hep.510300501
Graziadei IW, Wiesner RH, Marotta PJ, Porayko MK, Eileen Hay J, Charlton MR et al. Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. Hepatology. 1999;30(5):1121-1127. https://doi.org/10.1002/hep.510300501
Graziadei, Ivo W. ; Wiesner, Russell H. ; Marotta, Paul J. ; Porayko, Michael K. ; Eileen Hay, J. ; Charlton, Michael R. ; Poterucha, John J. ; Rosen, Charles B. ; Gores, Gregory James ; La Russo, Nicholas F ; Krom, Ruud A F. / Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. In: Hepatology. 1999 ; Vol. 30, No. 5. pp. 1121-1127.
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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 procto-colectomy after liver transplantation; 5 because of intractable symptoms related to inflammatory bowel disease and 4 due to the development of colorectal carcinoma/highgrade dysplasia. Our data show that liver transplantation provides excellent long- term patient and graft survival for patients with end-stage PSC.",
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AU - Porayko, Michael K.

AU - Eileen Hay, J.

AU - Charlton, Michael R.

AU - Poterucha, John J.

AU - Rosen, Charles B.

AU - Gores, Gregory James

AU - La Russo, Nicholas F

AU - Krom, Ruud A F

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N2 - 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 procto-colectomy after liver transplantation; 5 because of intractable symptoms related to inflammatory bowel disease and 4 due to the development of colorectal carcinoma/highgrade dysplasia. Our data show that liver transplantation provides excellent long- term patient and graft survival for patients with end-stage PSC.

AB - 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 procto-colectomy after liver transplantation; 5 because of intractable symptoms related to inflammatory bowel disease and 4 due to the development of colorectal carcinoma/highgrade dysplasia. Our data show that liver transplantation provides excellent long- term patient and graft survival for patients with end-stage PSC.

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