1. Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy
- Author
-
Bent Adel Hansen, Ulrika Broomé, Lars Bäckman, Styrbjörn Friman, Michael Olausson, Krister Höckerstedt, Kristian Bjøro, Heikki Mäkisalo, B Brandsaeter, Erik Schrumpf, Antti Oksanen, Preben Kirkegaard, Helena Isoniemi, and Bo-Göran Ericzon
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Cholangitis, Sclerosing ,Liver transplantation ,Malignancy ,digestive system ,Gastroenterology ,Primary sclerosing cholangitis ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Carcinoma ,Humans ,Contraindication ,Survival rate ,030304 developmental biology ,0303 health sciences ,Hepatology ,business.industry ,Contraindications ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Prognosis ,digestive system diseases ,Ursodeoxycholic acid ,3. Good health ,Liver Transplantation ,Transplantation ,Survival Rate ,Biliary Tract Neoplasms ,030211 gastroenterology & hepatology ,Female ,Gallbladder Neoplasms ,business ,Colorectal Neoplasms ,medicine.drug - Abstract
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.
- Published
- 2003