U. Broome et Ls. Eriksson, ASSESSMENT FOR LIVER-TRANSPLANTATION IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS, Journal of hepatology, 20(5), 1994, pp. 654-659
Recently three large studies have been presented in which the prognost
ic significance of clinical, laboratory and histological parameters me
asured early in the course of the disease was determined in primary sc
lerosing cholangitis patients. A different prognostic index was presen
ted in each study. The aim of the present study was to evaluate these
prognostic indices in a group of 37 patients with primary sclerosing c
holangitis, assessed for liver transplantation. The results are compar
ed to the outcome in the patients. At first referral, 12 patients were
considered too healthy for transplantation and 17 were accepted for t
ransplantation, six of whom died during the waiting time. Ten patients
had cholangiocarcinoma or hepatocellular cancer. Albumin and bilirubi
n differed significantly between the patients accepted for transplanta
tion and those considered too healthy. Only one prognostic index, pres
ented by Dickson et al., could discriminate between ''too healthy'' an
d ''in need of transplantation''. However, the overlap between the gro
ups was large, suggesting that this index may be of little or no help
in the clinical situation with individual patients. Moreover, neither
the prognostic index, nor any of the laboratory values could identify
the patients with cancer. It is concluded that prognostic indicators h
ave been found that may help to characterise primary sclerosing cholan
gitis patients. However, primary sclerosing cholangitis patients with
an accompanying cholangiocarcinoma still cannot be identified. (C) Jou
rnal of Hepatology.