| Theme |
PSC and PBC -- Recent Progress in Diagnosis and Treatment |
| Title |
Liver Transplantation for Primary Sclerosing Cholangitis |
| Author |
Atsushi Yoshizawa |
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Shinji Uemoto |
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University |
| [ Summary ] |
Primary sclerosing cholangitis (PSC) is a chronic, progressive inflammatory disease affecting the bile ducts, leading to fibrosis and eventually biliary cirrhosis. Its etiology has been elucidated but there are no established effective medical therapies at this time. The only curative treatment is liver transplantation (LTx). Recurrence of PSC (rPSC) after LTx becomes obvious while short-term graft and patient survival rates have improved. Recent data suggest that rPSC is progressive and associated with graft failure even though rPSC is difficult to distinguish from chronic rejection, biliary anastomotic strictures or humoral rejection after ABO-incompatible LTx. Several studies have shown the frequency of rPSC is approximately 20 % within 5 years. Several predicting factors for rPSC have been reported. The frequency of rPSC after living donor LTx, especially from Japan, was reported to be higher those from deceased donor LTxs in Western countries. A recent series of 114 PSC living donor LTxs in 29 institutions in Japan has shown that grafts from first-degree-relative donors, postoperative CMV infection, and early biliary anastomotic complications were significant graft risk factors. To improve graft survival rates post LTx for PSC, LTxs from deceased donors (non-relatives) should be promoted. |