Risk factors for recurrence of primary sclerosing cholangitis after living donor liver transplantation: a single center experience.
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.
Egawa
Hiroto
H
Organ Transplant Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan. egawa@kuhp.kyoto-u.ac.jp
Taira
Kaoru
K
Teramukai
Satoshi
S
Haga
Hironori
H
Ueda
Yoshihide
Y
Yonezawa
Atsushi
A
Masuda
Satohiro
S
Tsuji
Hiroaki
H
Ashihara
Eishi
E
Takada
Yasutsugu
Y
Uemoto
Shinji
S
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
D000998:Antiviral Agents; D000212:Acyclovir