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Recurrent primary sclerosing cholangitis after liver transplantation: a magnetic resonance cholangiography study with analyses of predictive factors.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2005 Nov; Vol. 11 (11), pp. 1361-9. - Publication Year :
- 2005
-
Abstract
- Primary sclerosing cholangitis (PSC) is a well-established indication for orthotopic liver transplantation (OLT), but post-OLT bile duct strictures complicate the outcome for these patients. These strictures might represent recurrent PSC (rPSC). To estimate the risk factors for post-OLT non-anastomotic bile duct strictures in PSC patients and to find their possible etiology, we performed magnetic resonance cholangiography (MRC) and angiography (MRA) in all PSC patients who had undergone OLT and were alive (median follow-up 6.4 years, range 1.4-15.2 years). This group of PSC patients was compared to a group of 45 non-PSC patients who had also undergone OLT. A logistic regression analysis was performed to find predictors of rPSC. Bile duct strictures were found in 19/49 PSC patients and in 4/45 non-PSC patients (P = 0.001). In the PSC group nine patients without other possible explanations for bile duct strictures than rPSC were identified, i.e., the estimated risk of rPSC was 9/49 (18%); surprisingly similar changes were also seen in one patient without a pre-transplant PSC diagnosis. Severe liver disease due to rPSC was seen in 4/9 patients (one patient died and three are being evaluated for re-OLT). Steroid-resistant rejection was the only significant predictor for rPSC. In conclusion, our study shows that by the use of MRC we found more bile duct strictures in PSC patients post-OLT compared to controls and that steroid-resistant rejections was a predictor of such changes.
- Subjects :
- Adult
Analysis of Variance
Case-Control Studies
Cholangitis, Sclerosing diagnosis
Female
Follow-Up Studies
Graft Survival
Humans
Immunosuppression Therapy methods
Incidence
Liver Transplantation methods
Magnetic Resonance Angiography methods
Magnetic Resonance Imaging methods
Male
Middle Aged
Predictive Value of Tests
Probability
Recurrence
Retrospective Studies
Risk Assessment
Severity of Illness Index
Cholangiography methods
Cholangitis, Sclerosing surgery
Graft Rejection epidemiology
Liver Transplantation adverse effects
Monitoring, Physiologic methods
Postoperative Complications diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6465
- Volume :
- 11
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 16184522
- Full Text :
- https://doi.org/10.1002/lt.20444