Orthotopic liver transplantation for cholestatic diseases.

Abstract

BACKGROUND/AIMS:

According to the data of the European Liver Transplant Registry (ELTR), liver transplantations (LTx) as a result of bile duct diseases were reported in 12.0% of cases. The aim of this study was to overview retrospective indications for operation and results of patients who underwent LTx for cholestatic diseases.

METHODOLOGY:

725 LTx were performed between January 1989 to December 2008, including 173 (23.9%) patients with cholestatic diseases. 80 pts (46.2%) were operated because of PBC, 63 pts (36.4%) with PSC and 12 pts (6.9%) with SBC as a result of iatrogenic bile ducts injuries. In 6 pts (3.5%) Caroli's disease was the reason for transplantation and another 11 pts (6.4%) were operated because of infiltration of alveococcosis into the bile duct. Cholangiocarcinoma (CCC) developed in 6 pts with PSC (9.5%) undergoing LTx. The last patient (0.6%) of our group was operated because of mucoviscidosis. 24 pts (13.9%) underwent unsuccessful surgical treatment prior to the LTx.

RESULTS:

142 pts (82.1%) presented good outcome, but complications in postoperative period were present in 31 pts (17.9%). 8 pts (4.6%) required re-laparotomy: 6 pts due to intraperitoneal bleeding and hematoma in the first postoperative week and 2 pts due to liver abscess, 1 month and 3 months after LTx respectivelly. 4 patients (2.3%) died in the first week after LTx (septic complications, acute rejection). 5 patients with CCC died in the period of 7 to 26 months after LTx. This was caused by the recurrence of the cancer. The overall mortality was 8.1% (14 pts). 4 pts (2.3%) underwent ReLTx due to various origins--one case due to hepatic artery thrombosis, another was ischemic type biliary lesion (ITBL) and two patients due to recurrence of PBC and PSC. Cumulative 1, 5 and 10 year recurrence-free survival rates after LTx were: 94.6% / 88.7% / 72.1% in PBC group, 95.3% / 86.5% / 70.2% in PSC group and 73.9% / 69.2% / 59.3% in SBC group of patients.

CONCLUSION:

There is no doubt that LTx is a good and effective option of treatment for patients with cholestatic diseases. Nevertheless the long-term benefits of LTx depend on precise indications and timing of the operation.

• Authors: W Patkowski, M Skalski, K Zieniewicz, P Nyckowski, P Smoter, M Krawczyk
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2010 May-Jun Vol. 57 Issue 99-100 Pg. 605-10 ISSN: 0172-6390 [Print] Greece
• PMID: 20698235 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Caroli Disease (surgery)
• Cholangitis, Sclerosing (surgery)
• Cholestasis (surgery)
• Cystic Fibrosis (surgery)
• Echinococcosis, Hepatic (surgery)
• Female
• Humans
• Liver Cirrhosis, Biliary (surgery)
• Liver Transplantation
• Male
• Middle Aged
• Retrospective Studies
• Severity of Illness Index