Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement

Abstract

Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of inflammatory bowel disease (IBD) and a lead indication for liver transplantation (LT) in the western world. In this article, we present a Consensus Statement on LT practice, developed by a dedicated Guidelines’ Taskforce of the European Society of Organ Transplantation (ESOT). The overarching goal is to provide practical guidance on commonly debated topics, including indications and timing of LT, management of bile duct stenosis in patients on the transplant waiting list, technical aspects of transplantation, immunosuppressive strategies post-transplant, timing and extension of intestinal resection and futility criteria for re-transplantation.

Primary sclerosing cholangitis and the risks of posttransplant lymphoproliferative disorder

“…[1] Although rare, PSC accounts for 10%-15% of European transplant practice and has emerged as the lead indication for transplantation in several countries. [2] However, 1 in 5 patients develop recurrent disease at 10 years, with graft loss rates exceeding that seen in all other etiologies. [3,4] Risk factors for disease recurrence have been studied extensively, with the lion's share of focus centering on managing concomitant inflammatory bowel disease (IBD) and comparing different immunosuppressive regimens.…”

“…[5] As PSC is an immune-mediated condition, it is common practice to administer "higher levels" of immunosuppression compared with, for instance, those transplanted for chronic viral hepatitis, hepatocellular carcinoma, or metabolic liver disease. [2] This is largely to mitigate risks of graft rejection, and, one would hope, the risks of recurrent disease. The latter is not necessarily an evidence-based practice, although a strategy adopted by many treating physicians.…”

“…Primary sclerosing cholangitis (PSC) is a chronic biliary disease for which liver transplantation is the only life-extending intervention 1 . Although rare, PSC accounts for 10%–15% of European transplant practice and has emerged as the lead indication for transplantation in several countries 2 . However, 1 in 5 patients develop recurrent disease at 10 years, with graft loss rates exceeding that seen in all other etiologies 3,4 .…”