Guest guest Posted July 16, 2004 Report Share Posted July 16, 2004 -----Original Message----- I've heard various percentages for PSC patients who do have recurrences. Here is a good web site about PSC - it includes several pictures (X-rays, ERCPS etc) http://www.emedicine.com/radio/topic155.htm - I have also included 2 studies below (please note date of studies). HTH Barb in Texas From Mayo - Hepatology. 1999 Apr. Recurrence of primary sclerosing cholangitis following liver transplantation.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.Liver Transplant Center, Mayo Clinic, Rochester, MN, USA.Recurrence of primary sclerosing cholangitis (PSC) following liver transplantation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. In the present study, we investigated the recurrence of PSC by developing strict criteria and applying them to a large cohort of PSC patients who underwent liver transplantation. Between March 1985 and June 1996, 150 PSC patients underwent liver transplantation at the Mayo Clinic; mean follow up was 55 months. The incidence of nonanastomotic biliary strictures and hepatic histologic findings suggestive of PSC were compared between patients transplanted for PSC and a non-PSC transplant control group. Our definition of recurrent PSC was based on characteristic cholangiographic and histologic findings that occur in nontransplant PSC patients. By using strict criteria, 30 patients with other known causes of posttransplant nonanastomotic biliary strictures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 patients (20%). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologic abnormalities with a mean time to diagnosis of 360 and 1,350 days, respectively. Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later onset of nonanastomotic biliary strictures in patients with PSC compared with a non-PSC control group is supportive of the fact that PSC does recur following liver transplantation. We were unable to identify specific clinical risk factors for recurrent PSC, and the overall patient and graft survival in patients with recurrent PSC was similar to those without evidence of recurrence. Our observations provide convincing evidence that PSC frequently recurs in the hepatic allograft using strict inclusion and exclusion criteria. PMID: 10094945 [PubMed - indexed for MEDLINE] Lancet. 2002 Dec 14. Risk factors for recurrence of primary sclerosing cholangitis of liver allograft.Liver Unit, Birmingham, UK.Primary sclerosing cholangitis (PSC) is a disease of unknown cause that effects the biliary tree and is closely associated with inflammatory bowel disease. We did a retrospective analysis of the risk factors associated with recurrence of PSC in an allograft after liver transplantation. Recurrence of disease, assessed by liver histology or imaging the biliary tree, occurred in 56 of 152 patients (37%) at a median of 36 months (range 1.4-120 months). Multivariate analysis showed that being male (relative risk 1.2, 95% CI 0.73-2.15) and an intact colon before transplantation (8.7, 1.19-64.48) were associated with recurrence. These observations could help elucidate the pathogenesis of the disease.PMID: 12493264 [PubMed - indexed for MEDLINE] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 18, 2004 Report Share Posted July 18, 2004 It's interesting because they talk about PSC recurring in patients' biliary trees. My doctor said that when they transplant me they're removing my bile ducts and connecting my liver directly to my duodenum. I have a feeling this transplantation procedure is different than the one that was used by the Mayo Clinic below. However, I'll have to dig through archives or someone will have to write me back with their experiences so I can conform that. Anyway, it's the reason my doctor said I can't get PSC. Oh, and my gallbladder will be gone too. -----Original Message-----From: Barb Henshaw Sent: July 16, 2004 10:37 AMTo: Subject: RE: PSC RECURRENCE -----Original Message----- I've heard various percentages for PSC patients who do have recurrences. Here is a good web site about PSC - it includes several pictures (X-rays, ERCPS etc) http://www.emedicine.com/radio/topic155.htm - I have also included 2 studies below (please note date of studies). HTH Barb in Texas From Mayo - Hepatology. 1999 Apr. Recurrence of primary sclerosing cholangitis following liver transplantation.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.Liver Transplant Center, Mayo Clinic, Rochester, MN, USA.Recurrence of primary sclerosing cholangitis (PSC) following liver transplantation has been suggested; however, it has not been fully defined because of numerous complicating factors and the lack of diagnostic criteria. In the present study, we investigated the recurrence of PSC by developing strict criteria and applying them to a large cohort of PSC patients who underwent liver transplantation. Between March 1985 and June 1996, 150 PSC patients underwent liver transplantation at the Mayo Clinic; mean follow up was 55 months. The incidence of nonanastomotic biliary strictures and hepatic histologic findings suggestive of PSC were compared between patients transplanted for PSC and a non-PSC transplant control group. Our definition of recurrent PSC was based on characteristic cholangiographic and histologic findings that occur in nontransplant PSC patients. By using strict criteria, 30 patients with other known causes of posttransplant nonanastomotic biliary strictures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 patients (20%). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologic abnormalities with a mean time to diagnosis of 360 and 1,350 days, respectively. Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later onset of nonanastomotic biliary strictures in patients with PSC compared with a non-PSC control group is supportive of the fact that PSC does recur following liver transplantation. We were unable to identify specific clinical risk factors for recurrent PSC, and the overall patient and graft survival in patients with recurrent PSC was similar to those without evidence of recurrence. Our observations provide convincing evidence that PSC frequently recurs in the hepatic allograft using strict inclusion and exclusion criteria. PMID: 10094945 [PubMed - indexed for MEDLINE] Lancet. 2002 Dec 14. Risk factors for recurrence of primary sclerosing cholangitis of liver allograft.Liver Unit, Birmingham, UK.Primary sclerosing cholangitis (PSC) is a disease of unknown cause that effects the biliary tree and is closely associated with inflammatory bowel disease. We did a retrospective analysis of the risk factors associated with recurrence of PSC in an allograft after liver transplantation. Recurrence of disease, assessed by liver histology or imaging the biliary tree, occurred in 56 of 152 patients (37%) at a median of 36 months (range 1.4-120 months). Multivariate analysis showed that being male (relative risk 1.2, 95% CI 0.73-2.15) and an intact colon before transplantation (8.7, 1.19-64.48) were associated with recurrence. These observations could help elucidate the pathogenesis of the disease.PMID: 12493264 [PubMed - indexed for MEDLINE] ---Incoming mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.716 / Virus Database: 472 - Release Date: 05/07/2004 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.716 / Virus Database: 472 - Release Date: 05/07/2004 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2004 Report Share Posted July 20, 2004 , I did have a bout of rejection about 3 months after my transplant, but that was the only hospitalization I had for almost 6 years. My labs were never normal and had been creeping up before the PTC tube went in. I never had the rush of energy so many people talk about after there transplants, but over all things were quite normal. > > It's interesting because they talk about PSC recurring in > patients' biliary > > trees. My doctor said that when they transplant me they're > removing my bile > > ducts and connecting my liver directly to my duodenum. I have a > feeling this > > transplantation procedure is different than the one that was used > by the > > Mayo Clinic below. However, I'll have to dig through archives or > someone > > will have to write me back with their experiences so I can conform > that. > > Anyway, it's the reason my doctor said I can't get PSC. Oh, and my > > gallbladder will be gone too. > > > > RE: PSC RECURRENCE > > > > > > -----Original Message----- I've heard various percentages for PSC > patients > > who do have recurrences. > > > > > > > > Here is a good web site about PSC - it includes several pictures > (X-rays, > > ERCPS etc) > > > > HYPERLINK " http://www.emedicine.com/radio/topic155.htm " > > http://www.emedicine.com/radio/topic155.htm - I have also included > 2 studies > > below (please note date of studies). HTH Barb in Texas > > > > > > From Mayo - Hepatology. 1999 Apr. > > > > HYPERLINK > > " http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi? > PrId=3058 & uid=10094945 > > & db=PubMed & url=http://dx.doi.org/10.1002/hep.510290427 " > > Recurrence of primary sclerosing cholangitis following liver > > transplantation. > > > > 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. > > > > Liver Transplant Center, Mayo Clinic, Rochester, MN, USA. > > > > Recurrence of primary sclerosing cholangitis (PSC) following liver > > transplantation has been suggested; however, it has not been fully > defined > > because of numerous complicating factors and the lack of diagnostic > > criteria. In the present study, we investigated the recurrence of > PSC by > > developing strict criteria and applying them to a large cohort of > PSC > > patients who underwent liver transplantation. Between March 1985 > and June > > 1996, 150 PSC patients underwent liver transplantation at the Mayo > Clinic; > > mean follow up was 55 months. The incidence of nonanastomotic > biliary > > strictures and hepatic histologic findings suggestive of PSC were > compared > > between patients transplanted for PSC and a non-PSC transplant > control > > group. Our definition of recurrent PSC was based on characteristic > > cholangiographic and histologic findings that occur in > nontransplant PSC > > patients. By using strict criteria, 30 patients with other known > causes of > > posttransplant nonanastomotic biliary strictures were excluded > leaving 120 > > patients for analysis of recurrence of PSC. We found evidence of > PSC > > recurrence after liver transplantation in 24 patients (20%). Of > these, 22 > > out of 24 patients showed characteristic features of PSC on > cholangiography > > and 11 out of 24 had compatible hepatic histologic abnormalities > with a mean > > time to diagnosis of 360 and 1,350 days, respectively. Both > cholangiographic > > and hepatic histologic findings suggestive of PSC recurrence were > seen in > > nine patients. The higher incidence and later onset of > nonanastomotic > > biliary strictures in patients with PSC compared with a non-PSC > control > > group is supportive of the fact that PSC does recur following liver > > transplantation. We were unable to identify specific clinical risk > factors > > for recurrent PSC, and the overall patient and graft survival in > patients > > with recurrent PSC was similar to those without evidence of > recurrence. Our > > observations provide convincing evidence that PSC frequently > recurs in the > > hepatic allograft using strict inclusion and exclusion criteria. > > > > > > > > PMID: 10094945 [PubMed - indexed for MEDLINE] > > > > > > > > Lancet. 2002 Dec 14. > > > > HYPERLINK > > " http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi? > PrId=3048 & uid=12493264 > > > & db=PubMed & url=http://linkinghub.elsevier.com/retrieve/pii/S014067360 > 2118617 > > " > > Risk factors for recurrence of primary sclerosing cholangitis of > liver > > allograft. > > > > Liver Unit, Birmingham, UK. > > > > Primary sclerosing cholangitis (PSC) is a disease of unknown cause > that > > effects the biliary tree and is closely associated with > inflammatory bowel > > disease. We did a retrospective analysis of the risk factors > associated with > > recurrence of PSC in an allograft after liver transplantation. > Recurrence of > > disease, assessed by liver histology or imaging the biliary tree, > occurred > > in 56 of 152 patients (37%) at a median of 36 months (range 1.4- > 120 months). > > Multivariate analysis showed that being male (relative risk 1.2, > 95% CI > > 0.73-2.15) and an intact colon before transplantation (8.7, 1.19- > 64.48) were > > associated with recurrence. These observations could help > elucidate the > > pathogenesis of the disease. > > > > PMID: 12493264 [PubMed - indexed for MEDLINE] > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2004 Report Share Posted July 20, 2004 > > > It's interesting because they talk about PSC recurring in > > patients' biliary > > > trees. My doctor said that when they transplant me they're > > removing my bile > > > ducts and connecting my liver directly to my duodenum. I have a > > feeling this > > > transplantation procedure is different than the one that was > used > > by the > > > Mayo Clinic below. However, I'll have to dig through archives or > > someone > > > will have to write me back with their experiences so I can > conform > > that. > > > Anyway, it's the reason my doctor said I can't get PSC. Oh, and > my > > > gallbladder will be gone too. > > > > > > RE: PSC RECURRENCE > > > > > > > > > -----Original Message----- I've heard various percentages for > PSC > > patients > > > who do have recurrences. > > > > > > > > > > > > Here is a good web site about PSC - it includes several pictures > > (X-rays, > > > ERCPS etc) > > > > > > HYPERLINK " http://www.emedicine.com/radio/topic155.htm " > > > http://www.emedicine.com/radio/topic155.htm - I have also > included > > 2 studies > > > below (please note date of studies). HTH Barb in Texas > > > > > > > > > From Mayo - Hepatology. 1999 Apr. > > > > > > HYPERLINK > > > " http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi? > > PrId=3058 & uid=10094945 > > > & db=PubMed & url=http://dx.doi.org/10.1002/hep.510290427 " > > > Recurrence of primary sclerosing cholangitis following liver > > > transplantation. > > > > > > 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. > > > > > > Liver Transplant Center, Mayo Clinic, Rochester, MN, USA. > > > > > > Recurrence of primary sclerosing cholangitis (PSC) following > liver > > > transplantation has been suggested; however, it has not been > fully > > defined > > > because of numerous complicating factors and the lack of > diagnostic > > > criteria. In the present study, we investigated the recurrence > of > > PSC by > > > developing strict criteria and applying them to a large cohort > of > > PSC > > > patients who underwent liver transplantation. Between March 1985 > > and June > > > 1996, 150 PSC patients underwent liver transplantation at the > Mayo > > Clinic; > > > mean follow up was 55 months. The incidence of nonanastomotic > > biliary > > > strictures and hepatic histologic findings suggestive of PSC > were > > compared > > > between patients transplanted for PSC and a non-PSC transplant > > control > > > group. Our definition of recurrent PSC was based on > characteristic > > > cholangiographic and histologic findings that occur in > > nontransplant PSC > > > patients. By using strict criteria, 30 patients with other known > > causes of > > > posttransplant nonanastomotic biliary strictures were excluded > > leaving 120 > > > patients for analysis of recurrence of PSC. We found evidence of > > PSC > > > recurrence after liver transplantation in 24 patients (20%). Of > > these, 22 > > > out of 24 patients showed characteristic features of PSC on > > cholangiography > > > and 11 out of 24 had compatible hepatic histologic abnormalities > > with a mean > > > time to diagnosis of 360 and 1,350 days, respectively. Both > > cholangiographic > > > and hepatic histologic findings suggestive of PSC recurrence > were > > seen in > > > nine patients. The higher incidence and later onset of > > nonanastomotic > > > biliary strictures in patients with PSC compared with a non- PSC > > control > > > group is supportive of the fact that PSC does recur following > liver > > > transplantation. We were unable to identify specific clinical > risk > > factors > > > for recurrent PSC, and the overall patient and graft survival in > > patients > > > with recurrent PSC was similar to those without evidence of > > recurrence. Our > > > observations provide convincing evidence that PSC frequently > > recurs in the > > > hepatic allograft using strict inclusion and exclusion criteria. > > > > > > > > > > > > PMID: 10094945 [PubMed - indexed for MEDLINE] > > > > > > > > > > > > Lancet. 2002 Dec 14. > > > > > > HYPERLINK > > > " http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi? > > PrId=3048 & uid=12493264 > > > > > > & db=PubMed & url=http://linkinghub.elsevier.com/retrieve/pii/S014067360 > > 2118617 > > > " > > > Risk factors for recurrence of primary sclerosing cholangitis of > > liver > > > allograft. > > > > > > Liver Unit, Birmingham, UK. > > > > > > Primary sclerosing cholangitis (PSC) is a disease of unknown > cause > > that > > > effects the biliary tree and is closely associated with > > inflammatory bowel > > > disease. We did a retrospective analysis of the risk factors > > associated with > > > recurrence of PSC in an allograft after liver transplantation. > > Recurrence of > > > disease, assessed by liver histology or imaging the biliary > tree, > > occurred > > > in 56 of 152 patients (37%) at a median of 36 months (range 1.4- > > 120 months). > > > Multivariate analysis showed that being male (relative risk 1.2, > > 95% CI > > > 0.73-2.15) and an intact colon before transplantation (8.7, 1.19- > > 64.48) were > > > associated with recurrence. These observations could help > > elucidate the > > > pathogenesis of the disease. > > > > > > PMID: 12493264 [PubMed - indexed for MEDLINE] > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2004 Report Share Posted July 20, 2004 , I haven't had any discomfort when the stents are placed, pre and post transplant. The PTC tube is more an inconvience then painful. I can't go swimming with and I need to change the dress and flush it, but like I said, they are just inconvenient. > > > It's interesting because they talk about PSC recurring in > > > > patients' biliary > > > > > trees. My doctor said that when they transplant me they're > > > > removing my bile > > > > > ducts and connecting my liver directly to my duodenum. I have a > > > > feeling this > > > > > transplantation procedure is different than the one that was used > > > > by the > > > > > Mayo Clinic below. However, I'll have to dig through archives or > > > > someone > > > > > will have to write me back with their experiences so I can conform > > > > that. > > > > > Anyway, it's the reason my doctor said I can't get PSC. Oh, and my > > > gallbladder will be gone too. > > > > > > RE: PSC RECURRENCE > > > > > > > > > -----Original Message----- I've heard various percentages for PSC > > > > patients > > > > > who do have recurrences. > > > > > > > > > > > > Here is a good web site about PSC - it includes several pictures > > > > (X-rays, > > > > > ERCPS etc) > > > > > > HYPERLINK " http://www.emedicine.com/radio/topic155.htm " > > > http://www.emedicine.com/radio/topic155.htm - I have also included > > > > 2 studies > > > > > below (please note date of studies). HTH Barb in Texas > > > > > > > > > From Mayo - Hepatology. 1999 Apr. > > > > > > HYPERLINK > > > " http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi? > > > > PrId=3058 & uid=10094945 > > > > > & db=PubMed & url=http://dx.doi.org/10.1002/hep.510290427 " > > > Recurrence of primary sclerosing cholangitis following liver > > > transplantation. > > > > > > 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. > > > > > Liver Transplant Center, Mayo Clinic, Rochester, MN, USA. > > > > > > Recurrence of primary sclerosing cholangitis (PSC) following liver > > > transplantation has been suggested; however, it has not been fully > > > > defined > > > > > because of numerous complicating factors and the lack of diagnostic > > > criteria. In the present study, we investigated the recurrence of > > > > PSC by > > > > > developing strict criteria and applying them to a large cohort of > > > > PSC > > > > > patients who underwent liver transplantation. Between March 1985 > > > > and June > > > > > 1996, 150 PSC patients underwent liver transplantation at the Mayo > > > > Clinic; > > > > > mean follow up was 55 months. The incidence of nonanastomotic > > > > biliary > > > > > strictures and hepatic histologic findings suggestive of PSC were > > > > compared > > > > > between patients transplanted for PSC and a non-PSC transplant > > > > control > > > > > group. Our definition of recurrent PSC was based on characteristic > > > cholangiographic and histologic findings that occur in > > > > nontransplant PSC > > > > > patients. By using strict criteria, 30 patients with other known > > > > causes of > > > > > posttransplant nonanastomotic biliary strictures were excluded > > > > leaving 120 > > > > > patients for analysis of recurrence of PSC. We found evidence of > > > > PSC > > > > > recurrence after liver transplantation in 24 patients (20%). Of > > > > these, 22 > > > > > out of 24 patients showed characteristic features of PSC on > > > > cholangiography > > > > > and 11 out of 24 had compatible hepatic histologic abnormalities > > > > with a mean > > > > > time to diagnosis of 360 and 1,350 days, respectively. Both > > > > cholangiographic > > > > > and hepatic histologic findings suggestive of PSC recurrence were > > > > seen in > > > > > nine patients. The higher incidence and later onset of > > > > nonanastomotic > > > > > biliary strictures in patients with PSC compared with a non- PSC > > > > control > > > > > group is supportive of the fact that PSC does recur following liver > > > transplantation. We were unable to identify specific clinical risk > > > > factors > > > > > for recurrent PSC, and the overall patient and graft survival in > > > > patients > > > > > with recurrent PSC was similar to those without evidence of > > > > recurrence. Our > > > > > observations provide convincing evidence that PSC frequently > > > > recurs in the > > > > > hepatic allograft using strict inclusion and exclusion criteria. > > > > > > > > > > > > PMID: 10094945 [PubMed - indexed for MEDLINE] > > > > > > > > > > > > Lancet. 2002 Dec 14. > > > > > > HYPERLINK > > > " http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi? > > > > PrId=3048 & uid=12493264 > > > > & db=PubMed & url=http://linkinghub.elsevier.com/retrieve/pii/S014067360 > > 2118617 > > > > > " > > > Risk factors for recurrence of primary sclerosing cholangitis of > > > > liver > > > > > allograft. > > > > > > Liver Unit, Birmingham, UK. > > > > > > Primary sclerosing cholangitis (PSC) is a disease of unknown cause > > > > that > > > > > effects the biliary tree and is closely associated with > > > > inflammatory bowel > > > > > disease. We did a retrospective analysis of the risk factors > > > > associated with > > > > > recurrence of PSC in an allograft after liver transplantation. > > > > Recurrence of > > > > > disease, assessed by liver histology or imaging the biliary tree, > > > > occurred > > > > > in 56 of 152 patients (37%) at a median of 36 months (range 1.4- > > > > 120 months). > > > > > Multivariate analysis showed that being male (relative risk 1.2, > > > > 95% CI > > > > > 0.73-2.15) and an intact colon before transplantation (8.7, 1.19- > > > > 64.48) were > > > > > associated with recurrence. These observations could help > > > > elucidate the > > > > > pathogenesis of the disease. > > > > > > PMID: 12493264 [PubMed - indexed for MEDLINE] > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 21, 2004 Report Share Posted July 21, 2004 > According to my transplant manual, it says recovery takes approximately 1 1/2 > to 3 months. After that you can go back to work and of course start slow and > work your way back up to your full duties. However, it's possible that some > people might take longer to recover. I worked up untill 4 months before my transplant as i could take it any more was just to tired to get out of bed. Had transplant on March 5th, and went back to work for Coca Cola on May 19th. Still have no problems as of yet. Randy PSC 2002 Liver transplant 3-5-04 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2004 Report Share Posted September 15, 2004 Dear Anne & Bobby; I am sorry to say that PSC can recur after liver transplantation, and the recurrence rate has been estimated by several groups; the numbers I have seen range anywhere from 1 to 37%, the average being about 15%. Let me know if you want to see the references on these numbers. Best regards, (father of (19); PSC 07/03; UC 08/03) > , that is FANTASTIC news....it does sound like you set a record!!! > How long after your first transplant did the PSC come back? My husband > had his 2-4-04 and he is beginning to have some of the symptoms he had > prior to the transplant...so the PSC is lurking in the back of my > mind...I don't think he could handle it right now so if it is going to > come back (God forbid) I was just wondering if there is a " norm " this > can happen. > > Anne & Bobby > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2004 Report Share Posted September 15, 2004 Dear ; Here are the numbers. Gopal DV, Corless CL, Rabkin JM, Olyaei AJ, Rosen HR 2003 Graft failure from severe recurrent primary sclerosing cholangitis following orthotopic liver transplantation. J. Clin. Gastroenterol. 37: 344-347. PMID: 14506394. " Speculation that primary sclerosing cholangitis (PSC) may recur in the transplanted liver is based on the relative increase in frequency of biliary abnormalities and histologic evidence of periportal fibrosis without other causes. A recent study demonstrated almost 9% of patients undergoing liver transplantation (OLT) for primary sclerosing cholangitis (PSC) develop recurrent sclerosing cholangitis although the patient and graft survival is not different from those in whom recurrence does not develop. Most reports of PSC recurrence post-OLT estimate rates of 1% to 14%, but to date, no center has reported rapidly progressive fibro-obliterative cholangitis leading to graft failure. " Graziadei IW 2002 Recurrence of primary sclerosing cholangitis after liver transplantation. Liver Transpl. 8: 575-581. PMID: 12089708. " Recurrence of PSC was defined in a recent study from the Mayo Clinic by means of strict cholangiographic and histological criteria in a large cohort of patients with PSC in whom other causes of biliary strictures were excluded. PSC recurrence was found in 20% of patients. No risk factor for PSC recurrence could be found, and recurrent disease did not influence patient or graft survival after a mean follow-up of 4.5 years. In conclusion, several studies provided convincing evidence that PSC recurs after OLT, with an incidence of 5% to 20% and an interval to diagnosis of at least 1 year after OLT. To date, patient and graft survival do not appear to be negatively affected by disease recurrence in the intermediate term of follow-up. " 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. PMID: 10094945. " By using strict criteria, 30 patients with other known causes of posttransplant nonanastomotic biliary strictures were excluded leaving 120 patients for analysis of recurrence of PSC. We found evidence of PSC recurrence after liver transplantation in 24 patients (20%). Of these, 22 out of 24 patients showed characteristic features of PSC on cholangiography and 11 out of 24 had compatible hepatic histologic abnormalities with a mean time to diagnosis of 360 and 1,350 days, respectively. Both cholangiographic and hepatic histologic findings suggestive of PSC recurrence were seen in nine patients. The higher incidence and later onset of nonanastomotic biliary strictures in patients with PSC compared with a non-PSC control group is supportive of the fact that PSC does recur following liver transplantation. We were unable to identify specific clinical risk factors for recurrent PSC, and the overall patient and graft survival in patients with recurrent PSC was similar to those without evidence of recurrence. Our observations provide convincing evidence that PSC frequently recurs in the hepatic allograft using strict inclusion and exclusion criteria. " 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. PMID: 12493264. " Recurrence of disease, assessed by liver histology or imaging the biliary tree, occurred in 56 of 152 patients (37%) at a median of 36 months (range 1.4-120 months). Multivariate analysis showed that being male (relative risk 1.2, 95% CI 0.73-2.15) and an intact colon before transplantation (8.7, 1.19-64.48) were associated with recurrence. These observations could help elucidate the pathogenesis of the disease. " 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. PMID: 11492975. " Finally, there is an increased incidence of both acute and chronic rejection, hepatic artery thrombosis and biliary stricturing in PSC patients undergoing liver transplantation. A late rise in serum alkaline phosphatase level is almost always indicative of biliary stricturing and recurrence of disease. Approximately 20% of patients followed for 5 years or more will have recurrence of PSC documented both on cholangiography and histology. " Yusoff IF, House AK, De Boer WB, Ferguson J, Garas G, Heath D, A, G 2002 Disease recurrence after liver transplantation in Western Australia. J. Gastroenterol. Hepatol. 17: 203-207. PMID: 11966952. " Recurrence rates by disease were: primary sclerosing cholangitis (17%), primary biliary cirrhosis (12%), autoimmune hepatitis (17%), hepatitis B (40%) and alcoholic liver disease (4%). Alcohol use relapse after transplantation occurred in 25%. The overall survival post-OLT was 87%, with a mean follow up of 53 months. Survival in patients with recurrent disease was 89%. CONCLUSIONS: Disease recurrence after OLT does occur, but overall, it is relatively uncommon. Recurrence rates vary significantly and depend, in part, on indication for OLT. With medium-term follow up, recurrent disease does not have an effect on mortality. " Sekido H, Takeda K, Morioka D, Kubota T, Tanaka K, Endo I, Nagahori K, Togo S, Shimada H 1999 Liver transplantation for primary sclerosing cholangitis. J. Hepatobiliary Pancreat. Surg. 6: 373-376. PMID: 10664284. " Recurrent sclerosing cholangitis is an important issue for posttransplant patients with primary sclerosing cholangitis, and occurs in 10%-20% of such patients. Although our understanding of recurrent sclerosing cholangitis is still in the early stages, its potential occurrence indicates the need for a longer follow-up period after liver transplantation. " I hope these references answer your questions. Let me know if you need further details. Best regards, Dave (father of (19); PSC 07/03; UC 08/03) > Yes, could I see the numbers? > > Also, is there a certain timeframe this occurs in..or is it just random? > Quote Link to comment Share on other sites More sharing options...
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