Surgery 1995 Feb;117(2):146-55

Primary sclerosing cholangitis: liver transplantation or biliary surgery

Farges O, Malassagne B, Sebagh M, Bismuth H

Abstract
BACKGROUND. Little information is available on the indications for, and the
efficacy and timing of, liver transplantation in patients with primary
sclerosing cholangitis (PSC). This issue is particularly relevant because
prolonged survival has been reported in patients who do not undergo
transplantation. METHODS. Long-term results of therapeutic interventions
including liver transplantation was assessed in a representative series of 51
patients. Patient survival was compared with that expected from prognostic
models. RESULTS. Actuarial symptom-free survival rate in patients treated by
nontransplantation biliary surgery (n = 23) was 35% at 10 years. Actuarial
survival rate from onset of PSC (56% at 10 years) was identical to that expected
from the prognostic model. Actuarial patient (n = 28) survival rate 5 years
after transplantation was greater than that expected from prognostic models (89%
versus 31%; p < 0.001). Previous abdominal surgery was associated with an
increased in-hospital mortality rate (p < 0.05). Cumulative actuarial incidence
of cancer 5 and 10 years after the onset of PSC was 13% and 31%, respectively.
CONCLUSIONS. Liver transplantation improves the prognosis of patients with PSC.
Failure to identify patients who will benefit from nontransplantation
therapeutic interventions or in whom a cancer will develop, and the risk
associated with previous abdominal surgery, suggest that liver transplantation
should be indicated early after onset of symptoms