Between February 26, 1981, and July 30, 1987, 36 patients underwent orthotopic
liver transplantation for
primary sclerosing cholangitis associated with
ulcerative colitis. Three of the 36 recipients died within 3 mo because of graft nonfunction or surgical complications. The other 33 (92%) lived for at least 1 yr. Two of the 33 died after 12 and 14 mo, respectively, of recurrent
cholangiocarcinoma that was not diagnosed before
transplantation. Four other patients died of recurrent
liver failure (three cases) or
immunoblastic sarcoma (one case) after 14, 21, 36 and 44 mo. Twenty-seven (75%) of the patients are still alive 23 to 81 mo after
transplantation. Two patients have been diagnosed as having
colorectal cancer 11 and 21 mo respectively, after
transplantation, for an overall incidence of 5.6% (2 of 36) and a corrected incidence of 6.5% (2 of 31) if the three early deaths and two later deaths caused by
cholangiocarcinomas are excluded. It is not known whether colorectal
malignancies were present but undetected at the time of
transplantation or whether they developed afterward. It is clear that patients who undergo
liver transplantation for
primary sclerosing cholangitis associated with
ulcerative colitis should have careful follow-up of the colon, including colonoscopy and multiple biopsies of the colorectal mucosa. Whether
proctocolectomy should be considered prophylactically after
liver transplantation is an unresolved issue.