Risk Factors for Recurrence of Primary Sclerosing Cholangitis After Living Donor Liver Transplantation: A Single Center Experience
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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.
KeywordsPrimary sclerosing cholangitis Living donor liver transplantation Cytomegalovirus Recurrence Risk factor
Primary sclerosing cholangitis
Living donor liver transplantation
Model for end-stage liver disease
Human leukocyte antigen
This work was funded by a Health Science Research Grant on a Specific Disease (Study of Intractable Liver and Biliary Diseases), The Ministry of Health, Labor and Welfare of Japan, 2005 to 2007.
- 14.Levitsky J, Singh N, Wagener MM, Stosor V, Abecassis M, Ison MG. A survey of CMV prevention strategies after liver transplantation. Am J Transplant. 2007;Oct 31 [Epub ahead of print].Google Scholar