SCLEROSING CHOLANGITIS FOLLOWING HUMAN ORTHOTOPIC LIVER-TRANSPLANTATION

Sclerosing cholangitis defined by cholangiographic criteria may occur after orthotopic liver transplantation. In this retrospective study, w e analyzed failed grafts and antecedent serial biopsies of 24 patients who developed this type of nonanastomotic biliary strictures. Scleros ing cholangitis was histologically diagnosed if there was a combinatio n of periductal fibrosis and features of large bile duct obstruction. The condition was observed in all but one available failed allografts. This later showed ischemic-type lesions without periductal fibrosis. Liver biopsy specimens were nondiagnostic relative to sclerosing chola ngitis, although 85% of the patients had evidence of large bile duct o bstruction. Numerous associated factors may explain the pathogenesis o f secondary sclerosing cholangitis: an immunologically related etiolog ic factor (10 recipients of ABO-incompatible allografts) and compromis ed arterial blood flow that likely resulted from hepatic artery thromb osis (12 patients), focal arterial fibrointimal hyperplasia (three pat ients), chronic ductopenic arteriopathic rejection (three patients) an d/or preservation-related ischemia (four patients). Sclerosing cholang itis may be a significant cause of graft failure that often has mislea ding biopsy manifestations. From a practical standpoint, cholestasis w ith evidence of large bile duct obstruction warrants cholangiographic assessment of the biliary tree.