Liver Transplantation for Primary Sclerosing Cholangitis; Predictors and Consequences of Hepatobiliary Malignancy

J Hepatol. 2004 May;40(5):815-22. doi: 10.1016/j.jhep.2004.01.002.

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.

MeSH terms

  • Adult
  • Biliary Tract Neoplasms / complications*
  • Carcinoma, Hepatocellular / complications
  • Cholangiocarcinoma / complications
  • Cholangitis, Sclerosing / complications*
  • Cholangitis, Sclerosing / mortality
  • Cholangitis, Sclerosing / surgery*
  • Colorectal Neoplasms / complications
  • Contraindications
  • Female
  • Gallbladder Neoplasms / complications
  • Humans
  • Liver Neoplasms / complications*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Prognosis
  • Survival Rate