Recurrence of primary sclerosing cholangitis following liver transplantation

Ivo W. Graziadei, Russell H. Wiesner, Kenneth P. Batts, Paul J. Marotta, Nicholas F La Russo, Michael K. Porayko, J. Eileen Hay, Gregory James Gores, Michael R. Charlton, Jurgen Ludwig, John J. Poterucha, Jeffery L. Steers, Ruud A F Krom

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Abstract

Recurrence of primary sclerosing cholangitis (PSC) following liver transplantation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. In the present study, we investigated the recurrence of PSC by developing strict criteria and applying them to a large cohort of PSC patients who underwent liver transplantation. Between March 1985 and June 1996, 150 PSC patients underwent liver transplantation at the Mayo Clinic; mean follow up was 55 months. The incidence of nonanastomotic biliary strictures and hepatic histologic findings suggestive of PSC were compared between patients transplanted for PSC and a non-PSC transplant control group. Our definition of recurrent PSC was based on characteristic cholangiographic and histologic findings that occur in nontransplant PSC patients. By using strict criteria, 30 patients with other known causes of posttransplant nonanastomotic biliary strictures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 patients (20%). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologic abnormalities with a mean time to diagnosis of 360 and 1,350 days, respectively. Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later onset of nonanastomotic biliary strictures in patients with PSC compared with a non-PSC control group is supportive of the fact that PSC does recur following liver transplantation. We were unable to identify specific clinical risk factors for recurrent PSC, and the overall patient and graft survival in patients with recurrent PSC was similar to those without evidence of recurrence. Our observations provide convincing evidence that PSC frequently recurs in the hepatic allograft using strict inclusion and exclusion criteria.

Original languageEnglish (US)
Pages (from-to)1050-1056
Number of pages7
JournalHepatology
Volume29
Issue number4
StatePublished - 1999

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Sclerosing Cholangitis
Liver Transplantation
Recurrence
Pathologic Constriction
Liver
Control Groups

ASJC Scopus subject areas

  • Hepatology

Cite this

Graziadei, I. W., Wiesner, R. H., Batts, K. P., Marotta, P. J., La Russo, N. F., Porayko, M. K., ... Krom, R. A. F. (1999). Recurrence of primary sclerosing cholangitis following liver transplantation. Hepatology, 29(4), 1050-1056.

Recurrence of primary sclerosing cholangitis following liver transplantation. / Graziadei, Ivo W.; Wiesner, Russell H.; Batts, Kenneth P.; Marotta, Paul J.; La Russo, Nicholas F; Porayko, Michael K.; Eileen Hay, J.; Gores, Gregory James; Charlton, Michael R.; Ludwig, Jurgen; Poterucha, John J.; Steers, Jeffery L.; Krom, Ruud A F.

In: Hepatology, Vol. 29, No. 4, 1999, p. 1050-1056.

Research output: Contribution to journalArticle

Graziadei, IW, Wiesner, RH, Batts, KP, Marotta, PJ, La Russo, NF, Porayko, MK, Eileen Hay, J, Gores, GJ, Charlton, MR, Ludwig, J, Poterucha, JJ, Steers, JL & Krom, RAF 1999, 'Recurrence of primary sclerosing cholangitis following liver transplantation', Hepatology, vol. 29, no. 4, pp. 1050-1056.
Graziadei IW, Wiesner RH, Batts KP, Marotta PJ, La Russo NF, Porayko MK et al. Recurrence of primary sclerosing cholangitis following liver transplantation. Hepatology. 1999;29(4):1050-1056.
Graziadei, Ivo W. ; Wiesner, Russell H. ; Batts, Kenneth P. ; Marotta, Paul J. ; La Russo, Nicholas F ; Porayko, Michael K. ; Eileen Hay, J. ; Gores, Gregory James ; Charlton, Michael R. ; Ludwig, Jurgen ; Poterucha, John J. ; Steers, Jeffery L. ; Krom, Ruud A F. / Recurrence of primary sclerosing cholangitis following liver transplantation. In: Hepatology. 1999 ; Vol. 29, No. 4. pp. 1050-1056.
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abstract = "Recurrence of primary sclerosing cholangitis (PSC) following liver transplantation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. In the present study, we investigated the recurrence of PSC by developing strict criteria and applying them to a large cohort of PSC patients who underwent liver transplantation. Between March 1985 and June 1996, 150 PSC patients underwent liver transplantation at the Mayo Clinic; mean follow up was 55 months. The incidence of nonanastomotic biliary strictures and hepatic histologic findings suggestive of PSC were compared between patients transplanted for PSC and a non-PSC transplant control group. Our definition of recurrent PSC was based on characteristic cholangiographic and histologic findings that occur in nontransplant PSC patients. By using strict criteria, 30 patients with other known causes of posttransplant nonanastomotic biliary strictures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 patients (20{\%}). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologic abnormalities with a mean time to diagnosis of 360 and 1,350 days, respectively. Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later onset of nonanastomotic biliary strictures in patients with PSC compared with a non-PSC control group is supportive of the fact that PSC does recur following liver transplantation. We were unable to identify specific clinical risk factors for recurrent PSC, and the overall patient and graft survival in patients with recurrent PSC was similar to those without evidence of recurrence. Our observations provide convincing evidence that PSC frequently recurs in the hepatic allograft using strict inclusion and exclusion criteria.",
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AU - Porayko, Michael K.

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AU - Gores, Gregory James

AU - Charlton, Michael R.

AU - Ludwig, Jurgen

AU - Poterucha, John J.

AU - Steers, Jeffery L.

AU - Krom, Ruud A F

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