title: Indications and Outcomes in Liver Transplantation in Patients With Primary Sclerosing Cholangitis in Norway.
abstract: BACKGROUND
  Primary sclerosing cholangitis (PSC) is 1 of the leading causes of liver transplantation (LTX) in Scandinavia, and an increasing number of PSC patients have been transplanted in Norway during the last 2 decades. This trend is partly attributable to the recently established practice in Norway of offering LTX to PSC patients with cholangiocellular dysplasia. Based on the controversy associated with this practice, we herein aimed to report the main features and outcomes of our LTX program in PSC.
  
  
  METHODS
  The primary indication for LTX (quality of life/end-stage liver disease or suspected neoplasia) was retrospectively determined for 222 patients undergoing LTX for PSC or other autoimmune liver diseases (primary biliary cirrhosis/autoimmune hepatitis) with at least 5 years of follow-up.
  
  
  RESULTS
  In PSC patients impaired quality of life (43.5%) and end-stage liver disease (38.4%) were the most frequent indications for LTX, whereas suspected neoplasia accounted for 18.1%. The proportion of PSC patients with manifest encephalopathy, variceal bleeding, or ascites declined over time. In patients with suspected neoplasia as the primary indication for LTX (n = 25), neoplasia was confirmed in the explanted liver in 20 patients (80%). Five-year survival rates for PSC patients transplanted between 2001 and 2009 were 91.9% for patients receiving LTX due to impaired quality of life or end-stage liver disease and 83.3% for suspected neoplasia.
  
  
  CONCLUSIONS
  The PSC patients are increasingly listed for LTX at an earlier stage of their liver disease. In patients with suspected neoplasia before LTX, 5-year survival was acceptable, despite confirmation of neoplasia in 80% of the liver explants.
authors: Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Ina M
authors: IM
authors: Andersen
authors: Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Bjarte
authors: B
authors: Fosby
authors: Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section of Gastroenterology, Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Kirsten M
authors: KM
authors: Boberg
authors: Department of Pathology, Clinic for Diagnostics and Intervention, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Ole P F
authors: OP
authors: Clausen
authors: Department of Pathology, Clinic for Diagnostics and Intervention, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Peter
authors: P
authors: Jebsen
authors: Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Espen
authors: E
authors: Melum
authors: Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Pål D
authors: PD
authors: Line
authors: Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Aksel
authors: A
authors: Foss
authors: Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section of Gastroenterology, Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Erik
authors: E
authors: Schrumpf
authors: Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Section of Gastroenterology, Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Tom H
authors: TH
authors: Karlsen