Primary sclerosing cholangitis (PSC): clinical, laboratory and survival analysis in children and adults

Background: Primary sclerosing cholangitis (PSC) is an uncommon disorder, r arely diagnosed in children, moreover, data on its natural history and surv ival are still lacking. Aim: The study was undertaken to compare clinical, laboratory and survival rates in two series of PSC: one in a pediatric grou p (group A) and the other in an adult population (group B). Methods: Group A included 9 patients (5 males, 4 females, mean age 10 yrs, range 7-15); gr oup B included 28 patients (19 males, 9 females, mean age 32 years, range 1 9-60). The mean follow-up was 5.2 years in group A and 6.9 years in group B (range 1-14 years). ERCP and colonoscopy were performed in each case. Surv ival was analyzed using the Kaplan-Meier method. Results: At presentation c hildren showed significantly higher levels of IgG and AST compared to adult s (p<0.05), moreover, interface hepatitis occurred in 50% of children and i n 14.2% in adults (p=ns). During follow-up the following major events occur red: oesophageal bleeding (n=2) in group A; progressive liver failure (n=6) , cholangiocarcinoma (n=3)? colonic cancer (n=1) in group B. Liver transpla ntation (OLTx) was performed in 4 adults tone died after a retransplantatio n). No deaths were observed in children. The Kapian-Meier curve in adults s hows a 65% rate of survival at 10 years. Conclusions: The present findings on PSC suggest a more severe activity of the disease in children than in ad ults at presentation; nonetheless, the prognosis seems to be better in chil dren than in adults. The Mayo score prognostic index does not predict the d evelopment of liver/colonic cancer. A poor outcome (defined as death or bei ng listed for OLTx) only occurred in adults.