Good Long-Term Outcomes in Patients With Primary Sclerosing Cholangitis Undergoing Living Donor Liver Transplantation

Abstract

Background: Primary sclerosing cholangitis (PSC) is a progressive cholestatic disorder with liver transplantation (LT) being the only definitive treatment in end-stage disease. Recurrence of PSC after LT is a significant concern which can lead to graft loss. The aim of this study is to find out the disease recurrence and long-term outcome after living donor liver transplantation (LDLT) in PSC. Methods: We conducted a retrospective review of all patients undergoing LDLT for PSC at our centre. Of 2268 adult LTs from August 2004 to July 2018, 32 (1.4%) patients underwent LDLT for PSC including 6 with PSC and autoimmune hepatitis overlap. The data were reviewed to look for PSC recurrence, complications, and overall survival. All patients received tacrolimus-based immunosuppression. Data are shown as number, percentage, median, and interquartile range (IQR). Result: The mean age of 32 LDLT recipients was 44 ± 12 years (males 22, females 10). At the time of transplantation, the mean child's score was 9 ± 1.6 and model for end-stage liver disease score was 18.9 ± 6.4. Ulcerative colitis was seen in 7 patients and none had cholangiocarcinoma. Majority of patients (n = 29) received right lobe graft and all but 3 underwent hepaticojejunostomy for biliary reconstruction. PSC recurrence was seen in 6 (20%) patients during a median follow-up of 59 (29-101) months, after exclusion of 2 patients with early mortality. A total of five patients died during follow-up, and one of these deaths was due to PSC recurrence. There were 2 perioperative deaths due to sepsis and 3 deaths on follow-up (sepsis in 2 and PSC recurrence in 1). Conclusion: LDLT can be performed in PSC with good overall long-term outcomes.

Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades

“…The data are consistent with other studies showing that LDLT has good long-term outcomes in patients with PSC. 19 The association of a later year of transplant with improved survival is consistent with studies showing that advancements in surgical techniques and experience with LDLT have improved recipient outcomes and minimized donor risk. 20 Another study found superior survival following LDLT compared to DDLT, 7 even in HCC patients with extended criteria.…”

Donor age (≥45 years) and reduced immunosuppression are associated with the recurrent primary sclerosing cholangitis after liver transplantation – a multicenter retrospective study

“…The effects of living‐related donors, especially first‐degree donors, on outcomes of LT recipients for PSC are still controversial with conflicting results [6,11,16,36]. Most recently, Indian study demonstrated excellent short‐term outcome in LDLT [37]. Regarding HLA, while the matching number in each HLA was not associated with the disease recurrence, total number of matching loci (4 and more) was associated with PSC recurrence in the univariate model among LDLT recipients, but did not reach significance in multivariate analysis.…”

Liver Transplant Outcomes in India

“…In the only published experience of LT for CLD secondary to primary sclerosing cholangitis, PSC recurrence was seen in 20% at a median follow-up of 59 (29-101) months after LDLT. 30…”