Clinically recurrent primary sclerosing cholangitis following liver transplantation: A time course

Campsen, Jeffrey; Zimmerman, Michael A.; Trotter, James F.; Wachs, Michael; Bak, Thomas; Steinberg, Tracy; Kam, Igal

doi:10.1002/lt.21313

Cited by 158 publications

(135 citation statements)

References 19 publications

(20 reference statements)

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“…The mTOR inhibitors are able to prevent acute cellular rejection after LT, and allow for reducing the exposure to calcineurin inhibitors, and thus acting as renal sparing agents [124] . Regarding prevention of HCC recurrence there are five retrospective studies with sirolimus [125][126][127][128][129] , whose results have been recently summarized in two meta-analyses [130,131] with the same conclusion:…”

Section: Strategies To Improve Outcome After Liver Transplantationmentioning

confidence: 94%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

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Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome. Core tip: Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. However, tumour recurrence rates are 15%-20% with a very poor prognosis. Strategies to minimize tumour recurrence and thus to improve outcome are focused in a careful selection of candidates for liver transplantation, an optimized management within waiting list and a tailored immunosuppression. The available scientific evidence supporting these strategies is reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more REVIEW Submit a

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Section: Strategies To Improve Outcome After Liver Transplantationmentioning

confidence: 94%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

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“…31 Pathological findings in the event of a recurrence are similar to those described in native livers with primary sclerosing cholangitis. 32,35,36 Diagnostic criteria of recurrent primary sclerosing cholangitis was based on the Mayo Clinic criteria 33 34 donorrecipient gender mismatch, 35 coexistent inflammatory bowel disease, the presence of an intact colon after liver transplant, 34 cytomegalovirus infection, 36 recurrent acute cellular rejection, 36 steroid-resistant acute cellular rejection, 36 maintenance of corticosteroid therapy, 37 and the presence of cholangiocarcinoma before liver transplant 38 (Table 4). In summary, although the mechanism of recurrence remains unknown, recent data argue for an association of recurrence with rejection and steroid therapy.…”

Section: Primary Sclerosing Cholangitismentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Liver retransplant is the only treatment for patients with irreversible graft failure. However, given the severe shortage of organs, there is an ethical question of equity in the distribution of this resource. Liver retransplant is more expensive and is associated with lower patient/graft survival rates than equivalent rates after primary transplant. Both primary nonfunction and hepatic artery thrombosis account for nearly all cases of early liver retransplant. Late indications of liver retransplantinclude chronic rejection, biliary complications, or recurrence of primary disease such as hepatitis C, autoimmune hepatitis, and primary sclerosing cholangitis. Donor data are not available when a patient is listed for liver retransplant; therefore, prognostic factors related to the recipient is a more practical way of making the decision to offer liver retransplant is made. In the Model of End-stage Liver Disease era liver retransplant for "late" indications is more complex and selection criteria are more stringent. We review the literature for predictive factors influencing outcome of liver retransplant, especially in those with recurrent disease.

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“…Orthotopic liver transplantation is the established treatment in PSC with 85% to 90% of 5-year survival rate (Gow & Chapman, 2000). However, 20 to 25% of transplanted patients develop recurrent PSC 5 to 10 years after transplant (Alabraba et al, 2009;Campsen et al, 2008;Graziadei et al, 1999;Navaneethan & Shen, 2010).…”

Section: Primary Sclerosing Cholangitis (Psc)mentioning

confidence: 99%