Association Between Reduced Levels of Alkaline Phosphatase and Survival Times of Patients With Primary Sclerosing Cholangitis

Lindström, Lars; Hultcrantz, Rolf; Boberg, Kirsten Muri; Friis-Liby, Ingalill; Bergquist, Annika

doi:10.1016/j.cgh.2012.12.032

Cited by 153 publications

(126 citation statements)

References 25 publications

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“…(20,21) Indeed, patients with biliary cirrhosis were more frequent in the CG without steatosis. In addition, high ALP indicates a more aggressive form of biliary cirrhosis, (22,23) whereas cofactors such as oxidative stress, steatosis, obesity, and alcohol intake (24) might be significant in biliary cirrhosis with low ALP, both before and after LT.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of steatosis after liver transplantation and patient outcomes

et al. 2016

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Steatosis occurs frequently after liver transplantation (LT). We aimed to determine the prevalence of steatosis in adult LT recipients, to determine the effects of significant (>33%; grades 2-3) steatosis on patient survival, and to identify risk factors for the development of significant steatosis and its effect on fibrosis progression. We retrospectively examined 2360 posttransplant biopsies of 548 LT recipients. Survival was compared between patients with significant steatosis and those with grades 0-1 steatosis. Patients with significant steatosis were compared to controls without steatosis (grade 0) for clinical and laboratory factors and fibrosis progression. Steatosis was found in 309 (56.4%) patients, including 93 (17.0%) patients with significant steatosis. Steatohepatitis (nonalcoholic fatty liver disease activity score 5) was diagnosed in 57 (10.4%) patients. The prevalence of steatosis increased from 30.3% at 1 year to 47.6% at 10 years after LT (P < 0.001). Survival times did not differ between groups (P 5 0.29). On multivariate analysis of pretransplant factors and initial immunosuppression (IS), alcohol-induced cirrhosis (P < 0.001) and high body mass index (BMI; P 5 0.002) were associated with the development of significant steatosis, whereas increased levels of alkaline phosphatase (P 5 0.01) and mycophenolate mofetil given initially (P 5 0.009) appeared to protect against significant steatosis. On multivariate analysis of posttransplant factors, high BMI (P < 0.001), serum triglycerides (P < 0.001), alcohol consumption (P 5 0.005), and type 2 diabetes mellitus (P 5 0.048) were associated with significant steatosis, whereas high creatinine (P 5 0.02) appeared to protect against significant steatosis. Significant steatosis was not associated with a higher fibrosis stage (P 5 0.62). Posttransplant steatosis affects 56.4% of LT recipients, and the prevalence increases with time after LT. Recipient factors and types of IS affect the risk for significant steatosis, which is not associated with a higher fibrosis stage or worse patient survival.Liver Transplantation 22 644-655 2016 AASLD.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of steatosis after liver transplantation and patient outcomes

et al. 2016

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“…If this occurs, it is felt to be a positive prognostic factor, with only 3% going on to liver decompensation, liver transplantation or liver-related death [35,36]. …”

Section: Natural History Of the Diseasementioning

confidence: 99%

Primary Sclerosing Cholangitis

Williamson

Chapman

2014

Dig Dis

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Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease caused by diffuse inflammation and fibrosis that can involve the entire biliary tree. It is a progressive disorder which can ultimately lead to biliary cirrhosis, portal hypertension and hepatic failure. PSC is a complex genetic disorder with male predominance. Environmental predisposing factors include non-smoking. It is closely associated with inflammatory bowel disease (IBD), particularly ulcerative colitis, which occurs in about two thirds of PSC cases. Recent studies have suggested that PSC-IBD is a separate disease entity from IBD alone with distinctive genetic and phenotypic characteristics. Most PSC patients are asymptomatic at presentation; clinical symptoms include fatigue, jaundice, weight loss, right upper quadrant pain and pruritis. Serum biochemical tests indicate cholestasis, and diagnosis is usually established by cholangiography. In symptomatic patients, median survival from presentation to death or liver transplantation is about 12 years. It is a premalignant condition, and the majority of deaths are from malignancy, particularly cholangiocarcinoma or colonic cancer. PSC has no curative treatment. Medical treatment with ursodeoxycholic acid may slow progression of the disease and reduce colonic dysplasia, though trials lack statistical significance. Liver transplantation is the only option in young patients with PSC and advanced liver disease.

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“…, and normalization of liver biochemistry in PSC is associated with a favorable prognosis31 . The normal liver biochemistry could be explained in part by mild liver involvement observed in subclinical PSC patients, supported by a low MRI progression score25 , which indicates a mild, non-or slowly progressive form of PSC.…”

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confidence: 99%

Prevalence of Sclerosing Cholangitis Detected by Magnetic Resonance Cholangiography in Patients With Long-term Inflammatory Bowel Disease

et al. 2016

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Using MRC analysis of patients with long-term IBD, we found the prevalence of PSC to be around 3-fold higher than that detected based on symptoms. Sixty-five percent of patients had subclinical PSC associated with progressive IBD, with no biochemical abnormalities and mild disease, based on radiology findings. PSC appears to progress in patients with subclinical disease, but long-term outcomes are not known.

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Association Between Reduced Levels of Alkaline Phosphatase and Survival Times of Patients With Primary Sclerosing Cholangitis

Cited by 153 publications

References 25 publications

Prevalence and risk factors of steatosis after liver transplantation and patient outcomes

Prevalence and risk factors of steatosis after liver transplantation and patient outcomes

Primary Sclerosing Cholangitis

Prevalence of Sclerosing Cholangitis Detected by Magnetic Resonance Cholangiography in Patients With Long-term Inflammatory Bowel Disease

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