Native liver xanthogranulomatous cholangiopathy in primary sclerosing cholangitis: impact on posttransplant outcome.
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.
Keaveny
Andrew Paul
AP
Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Gordon
Fredric David
FD
Goldar-Najafi
Atoussa
A
Lewis
William David
WD
Pomfret
Elizabeth Anne
EA
Pomposelli
James John
JJ
Jenkins
Roger Lewin
RL
Khettry
Urmila
U
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*