Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis - a retrospective multicenter analysis

Liver transplantation (LT) is the only definitive treatment for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC) but a high rate of biliary strictures (BS) and of recurrence (recPSC) has been reported. In this multicenter study we analyzed a large patient cohort with a long follow-up in order to evaluate the incidence of BS and of recPSC, to assess the impact on survival after LT and to identify risk factors. We collected clinical, surgical and laboratory data, records on inflammatory bowel disease (IBD), on immunosuppression, on recipient and graft outcome and on biliary complications (based on cholangiography and histology) of all patients who underwent LT for PSC in 10 German transplant centers between 01/1990 and 12/2006. 335 patients (68.4% men, mean age 38.9 years, 73.5% with IBD) were transplanted 8.8 years after PSC diagnosis and followed for 98.8 months. The one-, five- and ten-year recipient and graft survival was 90.7%, 84.8%, 79.4% and 79.2%, 69.1%, 62.4% respectively. BS were diagnosed in 36.1% after a mean time of 3.9 years and recPSC in 20.3% after 4.6 years. Both entities had a significant impact on long-term graft and recipient-survival. Independent risk factors for BS were donor age, ulcerative colitis, chronic ductopenic rejection, bilirubin and INR at LT. Independent risk factors for recPSC were donor age, IBD and INR at LT. These variables were able to categorize patients into risk groups for BS and recPSC.

CONCLUSION: BS and recPSC impact on long-term graft and patient survival after LT for PSC. Donor age, IBD and the INR at LT are independent risk factors for BS and recPSC and allow the risk estimation depending on the recipient-donor-constellation. This article is protected by copyright. All rights reserved.