Most recent PSC articles (continued)

[Guest guest]

Liver Transpl. 2007 Mar 29;13(4):552-557

Combined HLA-DR and -DQ disparity is associated with a stable course

of ulcerative colitis after liver transplantation for primary

sclerosing cholangitis.

Cholongitas E, Papatheodoridis GV, Zappoli P, kopoulos A, Patch

D, Marelli L, Shusang V, Kalambokis G, Shirling G, Rolando N,

Burroughs AK

Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital,

London, UK.

Combined disparity of human leukocyte antigen (HLA)-DR and -DQ

between mother and fetus is associated with less severe ulcerative

colitis (UC) during pregnancy. We evaluated whether donor-recipient

HLA disparity after liver transplantation (LT) affects UC in patients

with primary sclerosing cholangitis (PSC). Sixty-nine consecutive

patients with PSC underwent LT; all underwent colonoscopy before LT;

48 had UC before and 3 had de novo UC after LT. Clinical and

laboratory data, activity and treatment of UC, post-LT

cytomegalovirus infection, and disparity of HLA-A, -B, -DR, and -DQ

for each donor-recipient pair were evaluated. Pre-LT quiescent UC was

present in 26 patients. Post-LT UC activity was evaluated in 36 of 51

patients with UC who had not undergone pre-LT colectomy and who had

>12 months' post-LT survival. Of these, 16 were stable, 17 had

worsened, and 3 had de novo UC. Seven required colectomy (4 for

dysplasia or cancer) after LT. Post-LT cytomegalovirus viremia was

neither associated with worse UC activity (P = 0.58) nor de novo UC.

Disparity with respect to HLA-A, -B, -DR, and -DQ was found in 58%,

27%, 44%, and 39% donor-recipient pairs, respectively. Post-LT UC

course was similar with respect to single HLA disparity. However,

disparity in none or only one HLA-DR or -DQ was significantly

associated with worse activity compared with patients with disparity

at both (65% vs. 0%, P = 0.009). Logistic regression found that the

disparity for both -DR and -DQ was the only factor statistically

significantly associated with post-LT UC activity. We conclude that

disparity in both HLA-DR and -DQ between donor and recipient is

associated with stable UC activity after LT. PMID: 17394153

______________

Current Opinion in Gastroenterology. 23(3):310-316, May 2007.

Maggs, RL; Chapman, W

Sclerosing cholangitis.

Biliary tract

Abstract:

Purpose of review: Primary sclerosing cholangitis is a chronic

cholestatic liver disease characterized by strictures of the biliary

tree complicated by cirrhosis and cholangiocarcinoma. It is immune

mediated, although the precise aetiology remains unknown.

Recent findings: Research into etiopathogenesis and epidemiology,

diagnosis of cholangiocarcinoma, associations with inflammatory bowel

disease and autoimmune pancreatitis, and medical therapy are

discussed.

Summary: Multiple gene polymorphisms associated with primary

sclerosing cholangitis have been investigated. Common inflammatory

bowel disease-associated polymorphisms do not confer any

susceptibility to primary sclerosing cholangitis; the role of

intercellular adhesion molecule-1 gene polymorphisms and CCR5

mutations remain unclear. Elevated IgG4 has been demonstrated in a

subgroup of primary sclerosing cholangitis patients, which may

indicate an overlap with autoimmune pancreatitis and possible

responsiveness to steroids. Biliary brush cytology may assist in

diagnosis of cholangiocarcinoma, although further clinical indicators

are required. Animal studies suggest the superiority of 24-

norursodeoxycholic acid over ursodeoxycholic acid in reducing

histological disease progress; translational studies in humans are

now required.

______________

Dave R.