Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy.
OBJECTIVE
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.
Brandsaeter
B
B
Section of Hepatology and Gastroentrology, Department of Medicine, Rikshospitalet, 0027 Oslo, Norway. bjorn.brandsaeter@rikshospitalet.no
Isoniemi
Helena
H
Broomé
Ulrika
U
Olausson
Michael
M
Bäckman
Lars
L
Hansen
Bent
B
Schrumpf
Erik
E
Oksanen
Antti
A
Ericzon
Bo-Göran
BG
Höckerstedt
Krister
K
Mäkisalo
Heikki
H
Kirkegaard
Preben
P
Friman
Styrbjörn
S
Bjøro
Kristian
K
D000328:Adult; D001661:Biliary Tract Neoplasms / Q000150:complications*; D006528:Carcinoma, Hepatocellular / Q000150:complications; D018281:Cholangiocarcinoma / Q000150:complications; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications; D000075202:Contraindications; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate