title: Risk factors for recurrence of primary sclerosing cholangitis after living donor liver transplantation: a single center experience.
abstract: We retrospectively reviewed our 10-year experience with living donor liver transplantation (LDLT) in 30 consecutive patients with end-stage primary sclerosing cholangitis (PSC) to determine long-term patient and graft survival and risk factors for recurrence of PSC. For strict diagnosis of recurrence, patients with hepatic artery thrombosis (n = 2), ABO blood type incompatible transplantation (n = 3), and postoperative survival shorter than 1 year (n = 5) were excluded from the study, leaving 20 patients for analysis. Recurrence was diagnosed in 11 patients 26-71 months after transplantation. Multivariate analysis showed that cytomegalovirus diseases within 3 months after transplantation and related donors were independent risk factors for recurrence. When the effects on recurrence were compared among donor-recipient relationships, there were significant differences, especially between nonrelated donors and parents. Multivariate analysis showed that age was an independent risk factor for time to graft loss. Cytomegalovirus prophylaxis and avoidance of related donors are important in reducing PSC recurrence, although this is a preliminary report with limitations due to the small number of patients. LDLT for young patients with PSC using grafts from their parents might have to be avoided where deceased donor liver transplantation is available.
authors.affiliation: Organ Transplant Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan. egawa@kuhp.kyoto-u.ac.jp
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Taira
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Ueda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yonezawa
authors.forename: Satohiro
authors.initials: S
authors.lastname: Masuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tsuji
authors.forename: Eishi
authors.initials: E
authors.lastname: Ashihara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015209:Cholangitis, Sclerosing / Q000473:pathology*; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir