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Comparative Analysis of Outcomes in Living and Deceased Donor Liver Transplants for Primary Sclerosing Cholangitis

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Primary sclerosing cholangitits (PSC) is a progressive fibrosing cholangiopathy eventually leading to end-stage liver disease (ESLD). While literature for deceased donor liver transplantation (DDLT) for PSC abounds, only a few reports describe live donor liver transplant (LDLT) in the setting of PSC. We present a single-center experience on survival outcomes and disease recurrence for LDLT and DDLT for ESLD secondary to PSC.

Aim

The aim of this study was to analyze survival outcomes and disease recurrence for LDLT and DDLT for ESLD secondary to PSC.

Patients and Methods

A retrospective review of 58 primary liver transplants for PSC-associated ESLD, performed between May 1995 and January 2007, was done. Patients were divided into two groups based on donor status. Group 1 (n = 14) patients received grafts from living donors, while group 2 (n = 44) patients received grafts from deceased donors. An analysis of survival outcomes and disease recurrence was performed. Recurrence was confirmed based on radiological and histological criteria.

Results

Recurrence of PSC was observed in four patients in LDLT group and seven in DDLT group. Retransplantation was required in one patient in LDLT group and nine patients in DDLT group. One patient (7%) among LDLT and six patients (14%) among DDLT died. The difference in patient and graft survival was not statistically significant between the two groups (patient survival, p = 0.60; graft survival, p = 0.24).

Conclusion

This study demonstrates equivalent survival outcomes between LDLT and DDLT for PSC; however, the rate of recurrence may be higher in patients undergoing LDLT.

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References

  1. Chapman RW, Arborgh BA, Rhodes JM, et al. Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology. Gut 1980;21(10):870. doi:10.1136/gut.21.10.870.

    Article  CAS  PubMed  Google Scholar 

  2. Lee YM, Kaplan MM. Primary sclerosing cholangitis. N Engl J Med 1995;332(14):924. doi:10.1056/NEJM199504063321406.

    Article  CAS  PubMed  Google Scholar 

  3. Wiesner RH PM LN, Ludwig J. Primary sclerosing cholangitis. Diseases of the Liver: Lippincot 1993:411.

  4. Bjoro K, Schrumpf E. Liver transplantation for primary sclerosing cholangitis. J Hepatol 2004;40(4):570. doi:10.1016/j.jhep.2004.01.021.

    Article  PubMed  Google Scholar 

  5. Goss JA, Shackleton CR, Farmer DG, et al. Orthotopic liver transplantation for primary sclerosing cholangitis. A 12-year single center experience. Ann Surg 1997;225(5):472. doi:10.1097/00000658-199705000-00004.

    Article  CAS  PubMed  Google Scholar 

  6. Graziadei IW, Wiesner RH, Marotta PJ, et al. Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. Hepatology 1999;30(5):1121. doi:10.1002/hep.510300501.

    Article  CAS  PubMed  Google Scholar 

  7. Narumi S, Roberts JP, Emond JC, Lake J, Ascher NL. Liver transplantation for sclerosing cholangitis. Hepatology 1995;22(2):451. doi:10.1002/hep.1840220213.

    Article  CAS  PubMed  Google Scholar 

  8. Graziadei IW, Wiesner RH, Batts KP, et al. Recurrence of primary sclerosing cholangitis following liver transplantation. Hepatology 1999;29(4):1050. doi:10.1002/hep.510290427.

    Article  CAS  PubMed  Google Scholar 

  9. Harrison RF, Davies MH, Neuberger JM, Hubscher SG. Fibrous and obliterative cholangitis in liver allografts: evidence of recurrent primary sclerosing cholangitis? Hepatology 1994;20(2):356. doi:10.1002/hep.1840200214.

    Article  CAS  PubMed  Google Scholar 

  10. Kugelmas M, Spiegelman P, Osgood MJ, et al. Different immunosuppressive regimens and recurrence of primary sclerosing cholangitis after liver transplantation. Liver Transpl 2003;9(7):727. doi:10.1053/jlts.2003.50143.

    Article  PubMed  Google Scholar 

  11. Sheng R, Campbell WL, Zajko AB, Baron RL. Cholangiographic features of biliary strictures after liver transplantation for primary sclerosing cholangitis: evidence of recurrent disease. AJR Am J Roentgenol 1996;166(5):1109.

    CAS  PubMed  Google Scholar 

  12. Yamagiwa S, Ichida T. Recurrence of primary biliary cirrhosis and primary sclerosing cholangitis after liver transplantation in Japan. Hepatol Res 2007;37(Suppl 3):S449. doi:10.1111/j.1872-034X.2007.00250.x.

    Article  PubMed  Google Scholar 

  13. Hayashi PH, Forman L, Steinberg T, et al. Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients. Liver Transpl 2003;9(7):737. doi:10.1053/jlts.2003.50122.

    Article  PubMed  Google Scholar 

  14. Maheshwari A, Yoo HY, Thuluvath PJ. Long-term outcome of liver transplantation in patients with PSC: a comparative analysis with PBC. Am J Gastroenterol 2004;99(3):538. doi:10.1111/j.1572-0241.2004.04050.x.

    Article  PubMed  Google Scholar 

  15. Moon DB, Lee SG. Adult-to-adult living donor liver transplantation at the Asan Medical Center. Yonsei Med J 2004;45(6):1162.

    PubMed  Google Scholar 

  16. Soejima Y, Harada N, Shimada M, et al. Perioperative management and complications in donors related to living-donor liver transplantation. Surgery 2002;131(1):S195. doi:10.1067/msy.2002.119576.

    Article  PubMed  Google Scholar 

  17. Solano E, Khakhar A, Bloch M, et al. Liver transplantation for primary sclerosing cholangitis. Transplant Proc 2003;35(7):2431. doi:10.1016/j.transproceed.2003.09.017.

    Article  CAS  PubMed  Google Scholar 

  18. Jeyarajah DR, Netto GJ, Lee SP, et al. Recurrent primary sclerosing cholangitis after orthotopic liver transplantation: is chronic rejection part of the disease process? Transplantation 1998;66(10):1300. doi:10.1097/00007890-199811270-00006.

    Article  CAS  PubMed  Google Scholar 

  19. Kubota T, Thomson A, Clouston AD, et al. Clinicopathologic findings of recurrent primary sclerosing cholangitis after orthotopic liver transplantation. J Hepatobiliary Pancreat Surg 1999;6(4):377. doi:10.1007/s005340050134.

    Article  CAS  PubMed  Google Scholar 

  20. Liden H, Norrby J, Friman S, Olausson M. Liver transplantation for primary sclerosing cholangitis–a single-center experience. Transpl Int 2000;13(Suppl 1):S162. doi:10.1007/s001470050314.

    PubMed  Google Scholar 

  21. Vera A, Moledina S, Gunson B, et al. Risk factors for recurrence of primary sclerosing cholangitis of liver allograft. Lancet 2002;360(9349):1943. doi:10.1016/S0140-6736(02)11861-7.

    Article  PubMed  Google Scholar 

  22. Yusoff IF, House AK, De Boer WB, et al. Disease recurrence after liver transplantation in Western Australia. J Gastroenterol Hepatol 2002;17(2):203. doi:10.1046/j.1440-1746.2002.02632.x.

    Article  PubMed  Google Scholar 

  23. Akyildiz M, Karasu Z, Cagirgan S, Kilic M, Tokat Y. Rituximab therapy for life-threatining immune hemolytic anemia in a liver tranplant recipient: a case report. Transplant Proc 2004;36(5):1492. doi:10.1016/j.transproceed.2004.05.042.

    Article  CAS  PubMed  Google Scholar 

  24. Heimbach JK, Menon KV, Ishitani MB, et al. Living donor liver transplantation using a right lobe graft in an adult with situs inversus. Liver Transpl 2005;11(1):111. doi:10.1002/lt.20313.

    Article  PubMed  Google Scholar 

  25. Ikegami T, Nishizaki T, Yanaga K, et al. Living-related auxiliary partial orthotopic liver transplantation for primary sclerosing chonangitis–subsequent removal of the native liver. Hepatogastroenterology 1999;46(29):2951.

    CAS  PubMed  Google Scholar 

  26. Jabbour N, Gagandeep S, Mateo R, et al. Live donor liver transplantation: staging hepatectomy in a Jehovah's Witness recipient. J Hepatobiliary Pancreat Surg 2004;11(3):211. doi:10.1007/s00534-003-0877-0.

    Article  PubMed  Google Scholar 

  27. Kaibori M, Uemoto S, Fujita S, et al. Native hepatectomy after auxiliary partial orthotopic liver transplantation. Transpl Int 1999;12(5):383. doi:10.1111/j.1432-2277.1999.tb00626.x.

    Article  CAS  PubMed  Google Scholar 

  28. Nakamura M, Fuchinoue S, Nakajima I, et al. Three cases of sequential liver-kidney transplantation from living-related donors. Nephrol Dial Transplant 2001;16(1):166. doi:10.1093/ndt/16.1.166.

    Article  CAS  PubMed  Google Scholar 

  29. Oya H, Sato Y, Yamamoto S, Takeishi T, Kobayashi T, Hatakeyama K. Living related donor liver transplantation for primary sclerosing cholangitis with hepatocellular carcinoma and Crohn's disease: a case report. Transplant Proc 2004;36(8):2297. doi:10.1016/j.transproceed.2004.07.041.

    Article  CAS  PubMed  Google Scholar 

  30. Tamura S, Sugawara Y, Kaneko J, Matsui Y, Togashi J, Makuuchi M. Recurrence of primary sclerosing cholangitis after living donor liver transplantation. Liver Int 2007;27(1):86. doi:10.1111/j.1478-3231.2006.01395.x.

    Article  PubMed  Google Scholar 

  31. Varotti G, Gondolesi GE, Roayaie S, et al. Combined adult-to-adult living donor right lobe liver transplantation and pancreatoduodenectomy for distal bile duct adenocarcinoma in a patient with primary sclerosing cholangitis. J Am Coll Surg 2003;197(5):765. doi:10.1016/j.jamcollsurg.2003.06.001.

    Article  PubMed  Google Scholar 

  32. Wachs ME, Bak TE, Karrer FM, et al. Adult living donor liver transplantation using a right hepatic lobe. Transplantation 1998;66(10):1313. doi:10.1097/00007890-199811270-00008.

    Article  CAS  PubMed  Google Scholar 

  33. Boberg KM, Lundin KE, Schrumpf E. Etiology and pathogenesis in primary sclerosing cholangitis. Scand J Gastroenterol Suppl 1994;204:47. doi:10.3109/00365529409103625.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We would like to thank Ms. Meredith Gray for having helped us with this manuscript.

Conflicts of Interest

None.

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Authors and Affiliations

  1. Department of Surgery, Division of Solid Organ Transplantation, University of Rochester Medical Center, Box SURG, 601 Elmwood Avenue, Rochester, NY, 14642, USA

    Randeep Kashyap, Rajeev Sharma, Saman Safadjou, Yanjie Qi & Mark Orloff

  2. Department of Hepatology, Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA

    Parvez Mantry

  3. Department of Surgery, Geisinger Medical Center, Danville, PA, USA

    Manoj K. Maloo

  4. Department of Surgery, Temple University, Philadelphia, PA, USA

    Ashok Jain

  5. Department of Gastroenterology and Hepatology, URMC, Rochester, NY, USA

    Benedict Maliakkal

  6. Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA

    Charlotte Ryan

Authors
  1. Randeep Kashyap
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  2. Parvez Mantry
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  3. Rajeev Sharma
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Correspondence to Randeep Kashyap.

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Kashyap, R., Mantry, P., Sharma, R. et al. Comparative Analysis of Outcomes in Living and Deceased Donor Liver Transplants for Primary Sclerosing Cholangitis. J Gastrointest Surg 13, 1480–1486 (2009). https://doi.org/10.1007/s11605-009-0898-3

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  • DOI: https://doi.org/10.1007/s11605-009-0898-3

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