FIBROUS AND OBLITERATIVE CHOLANGITIS IN LIVER ALLOGRAFTS - EVIDENCE OF RECURRENT PRIMARY SCLEROSING CHOLANGITIS

Fibroobliterative lesions and fibrous cholangitis are characteristic h istological lesions of primary sclerosing cholangitis. To determine wh ether such lesions can be found in the liver allograft, and whether th ey represent recurrent disease, we reviewed all consecutive histologic al material taken at greater than 6 mo after transplantation in a 3-yr period from a series of 207 liver transplantations (22 with primary s clerosing cholangitis, 185 controls without primary sclerosing cholang itis). Because patients with primary sclerosing cholangitis have a bil iary system reconstructed by means of a Roux loop, we compared the fin dings with those from a further control group of patients who had rece ived a Roux loop for reasons other than primary sclerosing cholangitis . Of 22 patients receiving liver transplants for primary sclerosing ch olangitis, 7 (32%) patients had biopsy specimens showing features of b iliary obstruction, 6 (27%) showed fibrous cholangitis, and 3 (14%) sh owed classic fibroobliterative lesions. These findings compared with 3 (14%), 1 (5%) and 0 of 22 Roux controls, and 19 (10%), 4 (2%) and 0 o f 185 controls without primary sclerosing cholangitis, respectively. T he three patients with fibroobliterative lesions either had clinical e pisodes of cholangitis or had microorganisms in the large bile ducts. However, both biliary obstructive features and fibrous cholangitis wer e more common in primary sclerosing cholangitis, and fibroobliterative lesions were found only in patients who received transplants for prim ary sclerosing cholangitis, despite the presence of cholangitis and Ro ux loops in control patients. In conclusion, although some of these le sions could represent a secondary sclerosing cholangitis, our observat ions suggest that primary sclerosing cholangitis may recur in the live r allograft.