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Efficacy of hepatic transplantation in patients with primary sclerosing cholangitis

Abu-Elmagd, KM and Malinchoc, M and Dickson, ER and Fung, JJ and Murtaugh, PA and Langworthy, AL and Demetris, AJ and Krom, RAF and Van Thiel, DH and Starzl, TE (1993) Efficacy of hepatic transplantation in patients with primary sclerosing cholangitis. Surgery Gynecology and Obstetrics, 177 (4). 335 - 344. ISSN 0039-6087

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Abstract

Controlled trials to assess the therapeutic benefit of orthotopic hepatic transplantation (OHTx) for primary sclerosing cholangitis (PSC) cannot be justified in view of improvement of patient survival after this operation since 1981. However, the actual patient survival with OHTx can be compared with the Mayo model estimated survival probabilities without OHTx. This model, which encompasses physical, biochemical and histopathologic parameters of PSC, was constructed from a study of 392 conservatively treated PSC patients at five international centers in England and North America. We compared the actual survival of 216 adult patients with the diagnosis of advanced PSC who underwent hepatic replacement with the expected survival estimated by the Mayo PSC natural history model, 'the simulated control technique.' OHTx was performed at the University of Pittsburgh and Mayo Medical Center between 5 December 1981 and 26 December 1990. The mean (plus or minus standard deviation) post-OHTx follow-up period was 34 ± 25 months (range of zero to 104 months). Before transplantation, biliary or portal hypertensive operation, or both, was performed upon 104 patients. At operation, the mean age of recipients was 42.1 ± 11.3 years and the mean value of total serum bilirubin was 13.3 ± 13.0 milligrams per deciliter. Extensive septal fibrosis and cirrhosis were histologically documented in 97 percent of the patients, with splenomegaly in 63 percent. Immunosuppressive therapy was based primarily on cyclosporin in 184 recipients and FK-506 in 32. Within six months, the Kaplan-Meier survival probability after OHTx (0.89) already was higher than predicted by the Mayo model (0.83). At five years, the Kaplan-Meier actual survival with OHTx was 0.73 compared with 0.28 expected Mayo model survival. The overall increased survival rate with transplantation was statistically significant (chi-square equals 126.6; p<0.001). At all risk stratifications, OHTx significantly improved survival with a p value of 0.031 (low risk), 0.001 (moderate risk) and <0.001 (high risk). Thus, OHTx is effective therapy for PSC. Disease gravity and unsuspected cholangiocarcinoma in the excised native liver adversely influenced short and long term survival rates after transplantation, respectively.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Abu-Elmagd, KM
Malinchoc, M
Dickson, ER
Fung, JJ
Murtaugh, PA
Langworthy, AL
Demetris, AJ
Krom, RAF
Van Thiel, DH
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 13 October 1993
Date Type: Publication
Journal or Publication Title: Surgery Gynecology and Obstetrics
Volume: 177
Number: 4
Page Range: 335 - 344
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0039-6087
Other ID: uls-drl:31735062125798, Starzl CV No. 1596
Date Deposited: 08 Apr 2010 17:27
Last Modified: 27 Jan 2019 02:55
URI: http://d-scholarship.pitt.edu/id/eprint/4982

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