Re: Question re recurrence of PSC following liver transplant

[Guest guest]

Debbie,

I can't answer a numerical instance of recurrence following living

donor transplants; however, I did ask my transplant team about what

they would use for bile ducts before we were having numerous donors

evaluated for LDLT. Their response was the following in 2001:

" You ask an excellent question about the bile ducts and how they in

fact will be replaced. The fact is that we will not use your scarred

bile ducts at all. What they will do is to attach a portion of your

donor's bile duct to your intestines, so that once this liver begins

to produce bile, it will drain into the intestines to help metabolize

the foods that you eat. I hope that this sheds some light on the

subject. "

Perhaps someone who has had this procedure can give more details, but

you do get new plumbing in addition to a partial new liver. I would

imagine

that the donor keeps some of his/her bile ducts to continue this

function.

Take care,

Deb in VA

AIH 1997, PSC 1998, UC 1999, Listed Ltx 2001, MELD 20

His question asked specifically about the bile

> ducts, and if they are sclerosed so badly by the time a liver

> transplant is needed, how is it even possible that PSC DOESN'T

> return? I've never read anything suggesting bile ducts are

> transplanted as well.> I'm asking this question here because I

don't have any idea how to

> even research a question like this on the net.

>

> Thanks in advance for any light you can shed on this mystery.

>

> Debbie

[Guest guest]

The ducts run both inside (intahepatic ducts) and outside the liver

(extrahepatic ducts). When the liver is transplanted the ducts

inside the liver are obviously replaced by the new liver. A

procedure called a Roux-en-Y replaces the common bile duct with a

direct connection from the liver to the intestines thus eliminating

the extraheptic ducts. Recurrance of PSC would occur in the ducts

inside the new liver. The previous damage done by PSC would not be a

factor, if PSC does come back you are basically starting over.

in Seattle

> Hi all,

>

> My brother-in-law asked me about the recurrence of PSC following a

> liver transplant, and although I've read that it's rare, I know it

> sometimes does happen. His question asked specifically about the

bile

> ducts, and if they are sclerosed so badly by the time a liver

> transplant is needed, how is it even possible that PSC DOESN'T

> return? I've never read anything suggesting bile ducts are

> transplanted as well. And if that were the case, surely they could

be

> transplanted, or artificially made like a prothesis before PSC did

> damage to the liver in the first place. Maybe I don't fully

> understand how PSC progresses, or how the bile ducts are affected

in

> the course of the disease. From what I know right now (or think I

> know) the bile ducts are in pretty bad shape by the time a

transplant

> is needed.

>

> I'm asking this question here because I don't have any idea how to

> even research a question like this on the net.

>

> Thanks in advance for any light you can shed on this mystery.

>

> Debbie

[Guest guest]

The previous answers have explained the process well. If you'd like to

see a picture (drawing - not a photograph) of what is done go to:

http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease3 & organ=\

3 & disease=30 & lang_id=1 & pagetype=12 & pagenum=370#1819

You may need to paste the pieces of that long URL together in your

browser's address window to get it to display the page. Long lines

often get wrapped (broken into nice sized chunks) by either the

sending or receiving software.

PSC has been known to recur as quickly as 2 or 3 years from

transplant. I had recurrence diagnosed after 4 years and even though I

was told that recurrent PSC progresses more slowly than the original,

I think my transplanted liver will need replacement after 8 to 10

years (4 to 6 years after dx, whereas my first transplant was 9 years

after dx). Others in this group have had PSC recur after 16 years, so

there may be no time period after which one is " safe " from recurrence.

Tim R ltx 4/4/98

[Guest guest]

Hi Debbie;

Rates of recurrence of PSC have been estimated by several research

groups, and the rates reported range anywhere from 5 - 37%:

5 - 20%

Graziadei IW 2002 Recurrence of primary sclerosing cholangitis after

liver transplantation. Liver Transpl. 8: 575-581.

20%

Graziadei IW, Wiesner RH, Batts KP, Marotta PJ, LaRusso NF, Porayko

MK, Hay JE, Gores GJ, Charlton MR, Ludwig J, Poterucha JJ, Steers JL,

Krom RA 1999 Recurrence of primary sclerosing cholangitis following

liver transplantation. Hepatology 29: 1050-1056.

20%

Wiesner RH 2001 Liver transplantation for primary sclerosing

cholangitis: timing, outcome, impact of inflammatory bowel disease

and recurrence of disease. Best Pract. Res. Clin. Gastroenterol. 15:

667-680.

37%

Vera A, Moledina S, Gunson B, Hubscher S, Mirza D, Olliff S,

Neuberger J 2002 Risk factors for recurrence of primary sclerosing

cholangitis of liver allograft. Lancet 360: 1943-1944.

According to the last paper, the main risk factors for recurrence are

being male and having an intact colon before transplantation.

Best regards,

Dave

(father of (19); PSC 07/03; UC 08/03)

PRIMARY SCLEROSING CHOLANGITIS LITERATURE

http://home.insightbb.com/~rhodesdavid/

[Guest guest]

Debbie,

I had a liver transplant in 97. They removed all the diseased

ducts and my gall bladder. As noted in other replies, the new liver

is connected directly to the intestine. I have a recurrence of PSC

with now is destroying my transplanted liver and am currently back

on the transplant list. The numbers that I have seen say that there

is a 10 -20% chance for recurrence.

PSC/UC 1989, txl 6/1/97 relisted 7/04 Meld 23.

> Hi all,

>

> My brother-in-law asked me about the recurrence of PSC following a

> liver transplant, and although I've read that it's rare, I know it

> sometimes does happen. His question asked specifically about the

bile

> ducts, and if they are sclerosed so badly by the time a liver

> transplant is needed, how is it even possible that PSC DOESN'T

> return? I've never read anything suggesting bile ducts are

> transplanted as well. And if that were the case, surely they could

be

> transplanted, or artificially made like a prothesis before PSC did

> damage to the liver in the first place. Maybe I don't fully

> understand how PSC progresses, or how the bile ducts are affected

in

> the course of the disease. From what I know right now (or think I

> know) the bile ducts are in pretty bad shape by the time a

transplant

> is needed.

>

> I'm asking this question here because I don't have any idea how to

> even research a question like this on the net.

>>

> Debbie