Risk 4 Recurrence PSC After LDLT

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Risk Factors for Recurrence of Primary Sclerosing Cholangitis After Living Donor Liver Transplantation: A Single Center Experience

We retrospectively reviewed our 10-year experience

with living donor liver transplantation (LDLT) in 30 consecutive patients with

end-stage primary sclerosing cholangitis

(PSC) to determine long-term patient and graft survival and risk factors for

recurrence of PSC. For strict diagnosis of recurrence, patients with hepatic

artery thrombosis (n = 2),

ABO blood type incompatible transplantation (n = 3),

and postoperative survival shorter than 1 year (n = 5) were excluded from the study, leaving 20

patients for analysis. Recurrence was diagnosed in 11

patients 26–71 months after transplantation. Multivariate analysis

showed that cytomegalovirus diseases within 3 months after transplantation

and related donors were independent risk factors for recurrence. When the

effects on recurrence were compared among

donor-recipient relationships, there were significant differences, especially

between nonrelated donors and parents. Multivariate

analysis showed that age was an independent risk factor for time to graft loss.

Cytomegalovirus prophylaxis and avoidance of related donors are important in

reducing PSC recurrence, although this is a preliminary report with limitations

due to the small number of patients. LDLT for young patients with PSC using

grafts from their parents might have to be avoided

where deceased donor liver transplantation is available.

http://www.springerlink.com/content/6g56414v70715m4u/

Barb in Texas - Together in the Fight - Whatever it

Takes!

Son Ken (34) UC 91 PSC 99, LTX 6/21 &

6/30 2007 @ Baylor/Dallas

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Thanks Barb.Do you read this as saying for children who require transplant they should avoid getting live donor support from their bio parents (given we may have transferred the auto-immune predisposition for PSC)?Thanks,Don in Montgomery, Texas(Son, 7 with PSC)Sent from my Verizon Wireless BlackBerryFrom: "Barb Henshaw" Date: Fri, 13 Mar 2009 12:15:28 -0500To: < >Subject: Risk 4 Recurrence PSC After LDLT Risk Factors for Recurrence of Primary Sclerosing Cholangitis After Living Donor Liver Transplantation: A Single Center Experience We retrospectively reviewed our 10-year experience with living donor liver transplantation (LDLT) in 30 consecutive patients with end-stage primary sclerosing cholangitis (PSC) to determine long-term patient and graft survival and risk factors for recurrence of PSC. For strict diagnosis of recurrence, patients with hepatic artery thrombosis (n = 2), ABO blood type incompatible transplantation (n = 3), and postoperative survival shorter than 1 year (n = 5) were excluded from the study, leaving 20 patients for analysis. Recurrence was diagnosed in 11 patients 26–71 months after transplantation. Multivariate analysis showed that cytomegalovirus diseases within 3 months after transplantation and related donors were independent risk factors for recurrence. When the effects on recurrence were compared among donor-recipient relationships, there were significant differences, especially between nonrelated donors and parents. Multivariate analysis showed that age was an independent risk factor for time to graft loss. Cytomegalovirus prophylaxis and avoidance of related donors are important in reducing PSC recurrence, although this is a preliminary report with limitations due to the small number of patients. LDLT for young patients with PSC using grafts from their parents might have to be avoided where deceased donor liver transplantation is available. http://www.springerlink.com/content/6g56414v70715m4u/ Barb in Texas - Together in the Fight - Whatever it Takes! Son Ken (34) UC 91 PSC 99, LTX 6/21 & 6/30 2007 @ Baylor/Dallas

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Thanks Barb.Do you read this as saying for children who require transplant they should avoid getting live donor support from their bio parents (given we may have transferred the auto-immune predisposition for PSC)?Thanks,Don in Montgomery, Texas(Son, 7 with PSC)Sent from my Verizon Wireless BlackBerryFrom: "Barb Henshaw" Date: Fri, 13 Mar 2009 12:15:28 -0500To: < >Subject: Risk 4 Recurrence PSC After LDLT Risk Factors for Recurrence of Primary Sclerosing Cholangitis After Living Donor Liver Transplantation: A Single Center Experience We retrospectively reviewed our 10-year experience with living donor liver transplantation (LDLT) in 30 consecutive patients with end-stage primary sclerosing cholangitis (PSC) to determine long-term patient and graft survival and risk factors for recurrence of PSC. For strict diagnosis of recurrence, patients with hepatic artery thrombosis (n = 2), ABO blood type incompatible transplantation (n = 3), and postoperative survival shorter than 1 year (n = 5) were excluded from the study, leaving 20 patients for analysis. Recurrence was diagnosed in 11 patients 26–71 months after transplantation. Multivariate analysis showed that cytomegalovirus diseases within 3 months after transplantation and related donors were independent risk factors for recurrence. When the effects on recurrence were compared among donor-recipient relationships, there were significant differences, especially between nonrelated donors and parents. Multivariate analysis showed that age was an independent risk factor for time to graft loss. Cytomegalovirus prophylaxis and avoidance of related donors are important in reducing PSC recurrence, although this is a preliminary report with limitations due to the small number of patients. LDLT for young patients with PSC using grafts from their parents might have to be avoided where deceased donor liver transplantation is available. http://www.springerlink.com/content/6g56414v70715m4u/ Barb in Texas - Together in the Fight - Whatever it Takes! Son Ken (34) UC 91 PSC 99, LTX 6/21 & 6/30 2007 @ Baylor/Dallas

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Thank you Barb.Sent from my Verizon Wireless BlackBerryFrom: "Barb Henshaw" Date: Fri, 13 Mar 2009 13:52:27 -0500To: < >Subject: RE: Risk 4 Recurrence PSC After LDLT Don, I’m not a doctor…. I read the study this way: The hospital that did the study was in Japan. (IMHO you might have to acknowledge that things in another country may be quite different, one way or another). 20 patients is way, way too small of a group to take their findings as gospel. The study reported: “Multivariate analysis showed that cytomegalovirus diseases within 3 months after transplantation and related donors were independent risk factors for recurrence”. OK, so which was it? CMV, related donor or both??? This study reports you basically have a 50/50 (20/11) chance of rPSC, that may end up being true, but a much larger study would have to be done before we could give it any real credence. I “think” it takes 2 parents to create a child with PSC, two parents, not one, both with the exactly right set of DNA/genes, so a liver from just one parent, might not create another liver with PSC. But like I say I’m not a doctor and we need a larger study. Barb in Texas - Together in the Fight - Whatever it Takes! Son Ken (34) UC 91 PSC 99, LTX 6/21 & 6/30 2007 @ Baylor/Dallas -----Original Message-----Do you read this as saying for children who require transplant they should avoid getting live donor support from their bio parents (given we may have transferred the auto-immune predisposition for PSC)?