Outcome of patients with ischemic-like cholangiopathy with secondary sclerosing cholangitis after liver transplantation.

Abstract

BACKGROUND AND AIMS:

Sclerosing cholangitis in critically ill patients (SC-CIP) with sepsis and acute respiratory distress syndrome (ARDS) is a cholestatic liver disease with a rapid progression to liver cirrhosis and hepatic failure. Data on outcome of these patients after liver transplantation (LT) are sparse.

PATIENTS AND METHODS:

Eleven patients (46 ± 12 years; mean labMELD-score: 27 ± 7) with SC-CIP underwent LT. Six patients had severe polytrauma with multiple bone fractures, sepsis and ARDS. Five non-traumatic patients acquired SC-CIP during long-term intensive-care-unit stays due to sepsis and ARDS. Time to diagnosis, the microbiologic results and the survival rates after LT were evaluated.

RESULTS:

SC-CIP was diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) within 3 ± 1 months after manifestation of cholestasis and histologically confirmed in explanted livers. The predominant microorganisms isolated in bile were: Enterococcus and Candida albicans. Mean follow-up after LT was 28 ± 20 months. One female patient (non-traumatic) died due to sepsis 26 days after LT. All other patients left the hospital alive, but two (non-traumatic) patients died from sepsis, and one (traumatic) patient died in a hemorrhagic shock, thereafter. Seven of 11 patients (5 with polytrauma) are still alive and have a good quality of life. The survival of the SC-CIP patients after LT was comparable with that of patients transplanted due to alcoholic liver cirrhosis.

CONCLUSION:

SC-CIP develops rapidly within several months. Enterococcus and C. albicans were the main isolated microorganisms in the bile. Sepsis was the main cause of death after LT. Overall, SC-CIP is a good indication for LT in selected patients.

• Authors: Gabi I Kirchner, Marcus N Scherer, Aiman Obed, Petra Ruemmele, Reiner Wiest, Matthias Froh, Martin Loss, Hans-Juergen Schlitt, Juergen Schölmerich, Cornelia M Gelbmann
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 46 Issue 4 Pg. 471-8 (Apr 2011) ISSN: 1502-7708 [Electronic] England
• PMID: 21114429 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Bile (microbiology)
• Candida albicans
• Cholangitis, Sclerosing (complications, microbiology, mortality, surgery)
• Critical Care
• Critical Illness
• Enterococcus faecalis (isolation & purification)
• Enterococcus faecium (isolation & purification)
• Female
• Humans
• Liver Cirrhosis, Alcoholic (mortality, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Respiratory Distress Syndrome (complications)
• Sepsis (complications)
• Survival Rate
• Treatment Outcome