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Primary sclerosing cholangitis: liver transplantation or biliary surgery
- Source :
- Surgery. 117(2)
- Publication Year :
- 1995
-
Abstract
- Little information is available on the indications for, and the efficacy and timing of, liver transplantation in patients with primary sclerosing cholangitis (PSC). This issue is particularly relevant because prolonged survival has been reported in patients who do not undergo transplantation.Long-term results of therapeutic interventions including liver transplantation was assessed in a representative series of 51 patients. Patient survival was compared with that expected from prognostic models.Actuarial symptom-free survival rate in patients treated by nontransplantation biliary surgery (n = 23) was 35% at 10 years. Actuarial survival rate from onset of PSC (56% at 10 years) was identical to that expected from the prognostic model. Actuarial patient (n = 28) survival rate 5 years after transplantation was greater than that expected from prognostic models (89% versus 31%; p0.001). Previous abdominal surgery was associated with an increased in-hospital mortality rate (p0.05). Cumulative actuarial incidence of cancer 5 and 10 years after the onset of PSC was 13% and 31%, respectively.Liver transplantation improves the prognosis of patients with PSC. Failure to identify patients who will benefit from nontransplantation therapeutic interventions or in whom a cancer will develop, and the risk associated with previous abdominal surgery, suggest that liver transplantation should be indicated early after onset of symptoms.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Cholangitis, Sclerosing
Liver transplantation
Gastroenterology
Disease-Free Survival
Primary sclerosing cholangitis
Internal medicine
Medicine
Humans
Blood Transfusion
Survival rate
Proportional Hazards Models
Retrospective Studies
Intraoperative Care
business.industry
Proportional hazards model
Liver Neoplasms
Cancer
Retrospective cohort study
medicine.disease
Prognosis
Liver Transplantation
Transplantation
Biliary Tract Surgical Procedures
Treatment Outcome
Bile Duct Neoplasms
Drainage
Surgery
Female
business
Abdominal surgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 00396060
- Volume :
- 117
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....3fdb5136ca2e57abe6c81543b362131f