Outcome of patients with ischemic-like cholangiopathy with secondary sclerosing cholangitis after liver transplantation.
OBJECTIVE
Sclerosing cholangitis in critically ill patients (SC-CIP) with sepsis and acute respiratory distress syndrome (ARDS) is a cholestatic liver disease with a rapid progression to liver cirrhosis and hepatic failure. Data on outcome of these patients after liver transplantation (LT) are sparse.


METHODS
Eleven patients (46 ± 12 years; mean labMELD-score: 27 ± 7) with SC-CIP underwent LT. Six patients had severe polytrauma with multiple bone fractures, sepsis and ARDS. Five non-traumatic patients acquired SC-CIP during long-term intensive-care-unit stays due to sepsis and ARDS. Time to diagnosis, the microbiologic results and the survival rates after LT were evaluated.


RESULTS
SC-CIP was diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) within 3 ± 1 months after manifestation of cholestasis and histologically confirmed in explanted livers. The predominant microorganisms isolated in bile were: Enterococcus and Candida albicans. Mean follow-up after LT was 28 ± 20 months. One female patient (non-traumatic) died due to sepsis 26 days after LT. All other patients left the hospital alive, but two (non-traumatic) patients died from sepsis, and one (traumatic) patient died in a hemorrhagic shock, thereafter. Seven of 11 patients (5 with polytrauma) are still alive and have a good quality of life. The survival of the SC-CIP patients after LT was comparable with that of patients transplanted due to alcoholic liver cirrhosis.


CONCLUSIONS
SC-CIP develops rapidly within several months. Enterococcus and C. albicans were the main isolated microorganisms in the bile. Sepsis was the main cause of death after LT. Overall, SC-CIP is a good indication for LT in selected patients.
Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany. Gabriele.Kirchner@Klinik.uni-regensburg.de
Gabi I
GI
Kirchner
Marcus N
MN
Scherer
Aiman
A
Obed
Petra
P
Ruemmele
Reiner
R
Wiest
Matthias
M
Froh
Martin
M
Loss
Hans-Juergen
HJ
Schlitt
Juergen
J
Schölmerich
Cornelia M
CM
Gelbmann
D000328:Adult; D000368:Aged; D001646:Bile / Q000382:microbiology; D002176:Candida albicans; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D003422:Critical Care; D016638:Critical Illness; D013293:Enterococcus faecalis / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000150:complications; D018805:Sepsis / Q000150:complications; D015996:Survival Rate; D016896:Treatment Outcome