title: Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: A retrospective multicenter analysis.
abstract: Liver transplantation (LT) is the only definitive treatment for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC), but a high rate of biliary strictures (BSs) and of recurrent primary sclerosing cholangitis (recPSC) has been reported. In this multicenter study, we analyzed a large patient cohort with a long follow-up in order to evaluate the incidence of BS and recPSC, to assess the impact on survival after LT, and to identify risk factors. We collected clinical, surgical, and laboratory data and records on inflammatory bowel disease (IBD), immunosuppression, recipient and graft outcome, and biliary complications (based on cholangiography and histology) of all patients who underwent LT for PSC in 10 German transplant centers between January 1990 and December 2006; 335 patients (68.4% men; mean age, 38.9 years; 73.5% with IBD) underwent transplantation 8.8 years after PSC diagnosis with follow-up for 98.8 months. The 1-, 5-, and 10-year recipient and graft survival was 90.7%, 84.8%, 79.4% and 79.1%, 69.0%, 62.4%, respectively. BS was diagnosed in 36.1% after a mean time of 3.9 years, and recPSC was diagnosed in 20.3% after 4.6 years. Both entities had a significant impact on longterm graft and recipient survival. Independent risk factors for BS were donor age, ulcerative colitis, chronic ductopenic rejection, bilirubin, and international normalized ratio (INR) at LT. Independent risk factors for recPSC were donor age, IBD, and INR at LT. These variables were able to categorize patients into risk groups for BS and recPSC. In conclusion, BS and recPSC affect longterm graft and patient survival after LT for PSC. Donor age, IBD, and INR at LT are independent risk factors for BS and recPSC and allow for risk estimation depending on the recipient-donor constellation.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Hildebrand
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Pannicke
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Essen, Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechene
authors.affiliation: Department of Medicine, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Gotthardt
authors.affiliation: Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kirchner
authors.affiliation: Department of Medicine II, Liver Center Munich, University of Munich, Munich, Germany.
authors.forename: Florian P
authors.initials: FP
authors.lastname: Reiter
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Sterneck
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Herzer
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Henrike
authors.initials: H
authors.lastname: Lenzen
authors.affiliation: Department of Medicine, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rupp
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Barg-Hock
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: de Leuw
authors.affiliation: Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany.|Department of Medicine I, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Teufel
authors.affiliation: Department of Medicine II, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Vincent
authors.initials: V
authors.lastname: Zimmer
authors.affiliation: Department of Medicine II, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lammert
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.affiliation: Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spengler
authors.affiliation: Department of Medicine II, Liver Center Munich, University of Munich, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rust
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.affiliation: 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schramm
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|Department of Internal Medicine I, University of Bonn, Bonn, Germany.
authors.forename: Tobias J
authors.initials: TJ
authors.lastname: Weismüller
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000453:epidemiology*; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003251:Constriction, Pathologic / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult