Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy

BACKGROUND/AIMS: Hepatobiliary malignancies are frequently seen in primary sclerosing cholangitis (PSC) and they complicate the evaluation of patients and timing of liver transplantation. METHODS: Data from all Nordic PSC patients listed for liver transplantation during 1990-2001 were recorded prospectively. Predictors of hepatobiliary malignancy and patient survival rates have been analysed. RESULTS: Hepatobiliary malignancy was found in 52/255 (20%) patients accepted to the waiting list. Recent diagnosis of PSC, no ursodeoxycholic acid (UDCA) treatment, clinical suspicion and previous colorectal-cancer were predictors of malignancy. Among 89 patients with a strong suspicion of malignancy prior to acceptance, 35 (39%) had confirmed malignancy. A clinical suspicion had been raised in 35/52 (67%) patients with malignancy. Malignancy was found in 31/223 patients who received a liver allograft. The 1-, 3- and 5-year patient survival rates following transplantation for patients with PSC and cholangiocarcinoma were 65, 35 and 35%, respectively. CONCLUSIONS: Hepatobiliary malignancy is suspected in 1/3 of the PSC patients and found in 1/5. Although cholangiocarcinoma is regarded as a contraindication to liver transplantation (LTX), PSC patients with cholangiocarcinoma had a 35% 5-year survival following transplantation.

Isoniemi, H. (author)
Broome, U. (author)
Olausson, Michael,1956Gothenburg University,Göteborgs universitet,Institutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi,Institute of Surgical Sciences, Department of Surgery(Swepub:gu)xolami (author)
Backman, L. (author)
Hansen, B. (author)
Schrumpf, E. (author)
Oksanen, A. (author)
Ericzon, B. G. (author)
Hockerstedt, K. (author)
Makisalo, H. (author)
Kirkegaard, P. (author)
Friman, Styrbjörn,1948Gothenburg University,Göteborgs universitet,Institutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi,Institute of Surgical Sciences, Department of Surgery(Swepub:gu)xfrist (author)
Bjoro, K. (author)
Karolinska InstitutetInstitutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi (creator_code:org_t)

By the author/editor: Brandsaeter, B.; Isoniemi, H.; Broome, U.; Olausson, Michae ...; Backman, L.; Hansen, B.; show more...; Schrumpf, E.; Oksanen, A.; Ericzon, B. G.; Hockerstedt, K.; Makisalo, H.; Kirkegaard, P.; Friman, Styrbjör ...; Bjoro, K.; show less...

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