title: Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy.
abstract: 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.
authors.affiliation: Section of Hepatology and Gastroentrology, Department of Medicine, Rikshospitalet, 0027 Oslo, Norway. bjorn.brandsaeter@rikshospitalet.no
authors.forename: B
authors.initials: B
authors.lastname: Brandsaeter
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
authors.forename: Ulrika
authors.initials: U
authors.lastname: Broomé
authors.forename: Michael
authors.initials: M
authors.lastname: Olausson
authors.forename: Lars
authors.initials: L
authors.lastname: Bäckman
authors.forename: Bent
authors.initials: B
authors.lastname: Hansen
authors.forename: Erik
authors.initials: E
authors.lastname: Schrumpf
authors.forename: Antti
authors.initials: A
authors.lastname: Oksanen
authors.forename: Bo-Göran
authors.initials: BG
authors.lastname: Ericzon
authors.forename: Krister
authors.initials: K
authors.lastname: Höckerstedt
authors.forename: Heikki
authors.initials: H
authors.lastname: Mäkisalo
authors.forename: Preben
authors.initials: P
authors.lastname: Kirkegaard
authors.forename: Styrbjörn
authors.initials: S
authors.lastname: Friman
authors.forename: Kristian
authors.initials: K
authors.lastname: Bjøro
mesh_terms: 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