Long-term results of patients undergoing liver transplantation for primarysclerosing cholangitis

Liver transplantation is the only effective therapeutic option for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC). In this study, we analyzed a single center's experience with 150 consecutiv e PSC patients who received 174 liver allografts. Mean follow-up was 55 mon ths. Actuarial patient survival at 1, 2, 5, and 10 years was 93.7%, 92.2%, 86.4%, and 69.8%, respectively, whereas graft survival was 83.4%, 83.4%, 79 .0%, and 60.5%, respectively. The main indication for retransplantation was hepatic artery thrombosis, and the major cause of death was severe infecti on. Patients with PSC had a higher incidence of acute cellular and chronic ductopenic rejection compared to a non-PSC control group. Chronic ductopeni c rejection adversely affected patient and graft survival. Biliary strictur es, both anastomotic and nonanastomotic, were frequent and occurred in 16.2 % and 27.2% of patients, respectively. The incidence of recurrent PSC was 2 0%. A negative impact on patient survival was not seen in patients with eit her postoperative biliary strictures or recurrence of PSC. Six patients (4% ) had cholangiocarcinoma and 1 patient died related to recurrence of malign ant disease. Seventy-eight percent of PSC patients had associated inflammat ory bowel disease, most commonly chronic ulcerative colitis, which did not adversely impact patient outcome posttransplantation. Nine patients require d proctocolectomy after liver transplantation; 5 because of intractable sym ptoms related to inflammatory bowel disease and. 4 due to the development o f colorectal carcinoma/high-grade dysplasia. Our data show that liver trans plantation provides excellent long-term patient and graft survival for pati ents with end-stage PSC.