Recurrence of primary sclerosing cholangitis following liver transplantation

Recurrence of primary sclerosing cholangitis (PSC) following Liver transpla ntation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. In th e 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 u nderwent liver transplantation at the Mayo Clinic; mean follow up was 55 mo nths. The incidence of nonanastomotic biliary strictures and hepatic histol ogic findings suggestive of PSC were compared between patients transplanted For PSC and a non-PSC transplant control group. Our definition of recurren t PSC was based on characteristic cholangiographic and histologic findings that occur in nontransplant PSC patients. By using strict criteria, 30 pati ents with other known causes of posttransplant nonanastomotic biliary stric tures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 pati ents (20%). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologi c abnormalities with a mean time to diagnosis of 360 and 1,350 days, respec tively Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later o nset of nonanastomotic biliary strictures in patients with PSC compared wit h a non-PSC control group is supportive of the fact that PSC does recur fol lowing 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 rec urrence. Our observations provide convincing evidence that PSC frequently r ecurs in the hepatic allograft using strict inclusion and exclusion criteri a.