LIVER-TRANSPLANTATION FOR PRIMARY BILIARY-CIRRHOSIS AND PRIMARY SCLEROSING CHOLANGITIS - PREDICTING OUTCOMES WITH NATURAL-HISTORY MODELS

In patients with primary biliary cirrhosis (PBC) and primary sclerosin g cholangitis (PSC), risk score models that reflect disease severity h ave been developed and can serve as an objective measurement to assess and evaluate the effect of the severity of liver disease on the outco me of liver transplantation. Thus, using the established Mayo risk sco res for PBC and PSC, one not only can estimate survival for the indivi dual patient but can measure disease activity as well. Indeed, several studies have suggested that the optimal timing of liver transplantati on with use of the Mayo PBC model may be an important tool to improve survival, decrease morbidity, and decrease overall related costs. Like wise, studies in patients with PSC have yielded similar results. This review explores how prognostic mathematical survival models for PBC an d PSC might be applied to individual patients in need of liver transpl antation. The following question is addressed: How can the timing of l iver transplantation be optimized to increase survival, decrease posto perative morbidity, and, ultimately, decrease the overall resource uti lization involved in this procedure?.