title: Native liver xanthogranulomatous cholangiopathy in primary sclerosing cholangitis: impact on posttransplant outcome.
abstract: A retrospective analysis of 51 primary sclerosing cholangitis (PSC) patients who underwent liver transplant (LT) identified 16 with xanthogranulomatous cholangiopathy (XGC) at the native liver hilum. Pre-LT clinical and laboratory data and post-LT course and outcome of patients with XGC were compared with the 35 PSC patients without XGC. The XGC and non-XGC groups were similar with respect to age and laboratory data at the time of LT. Pre-LT cholecystectomy was performed in 44% versus 26% and biliary bypass procedure in 38% versus 26% of patients with and without XGC, respectively (P = NS). Peri-operative complications resulted in six (38%) deaths or retransplantation within 60 days of LT in the XGC group compared with 4 (11%) in the non-XGC group (P =.05). Patient survival at 60 and 100 days post-LT was better in the non-XGC group (P =.01). The causes of death or retransplantation within 60 days post-LT in the patients with XGC included primary nongraft function (1), uncontrolled bleeding (3), and sepsis (2), while in the non-XGC group these were uncontrolled bleeding (2), sepsis (1), and primary nongraft function (1). Mean graft survival +/- SD was 1,081 +/- 1,584 days in patients with XGC versus 2,149 +/- 1,679 days in patients without XGC. The presence of XGC in the native liver hilum of PSC patients undergoing LT was associated with a higher rate of early post-LT mortality or retransplantation. In conclusion, no pre-LT clinical features or laboratory tests were identified that predicted the presence of XGC in PSC patients.
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
authors.forename: Andrew Paul
authors.initials: AP
authors.lastname: Keaveny
authors.forename: Fredric David
authors.initials: FD
authors.lastname: Gordon
authors.forename: Atoussa
authors.initials: A
authors.lastname: Goldar-Najafi
authors.forename: William David
authors.initials: WD
authors.lastname: Lewis
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: Pomfret
authors.forename: James John
authors.initials: JJ
authors.lastname: Pomposelli
authors.forename: Roger Lewin
authors.initials: RL
authors.lastname: Jenkins
authors.forename: Urmila
authors.initials: U
authors.lastname: Khettry
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000473:pathology / Q000601:surgery*; D006085:Graft Survival; D006099:Granuloma / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D012086:Reoperation; D016896:Treatment Outcome; D014973:Xanthomatosis / Q000473:pathology*