Brandsaeter Bjorn, Schrumpf Erik, Bentdal Oystein, Brabrand Kurt, Smith Hans Jorgen, Abildgaard Andreas, Clausen Ole Petter, Bjoro Kristian
Department of Medicine, Rikshospitalet, Oslo, Norway.
Liver Transpl. 2005 Nov;11(11):1361-9. doi: 10.1002/lt.20444.
Primary sclerosing cholangitis (PSC) is a well-established indication for orthotopic liver transplantation (OLT), but post-OLT bile duct strictures complicate the outcome for these patients. These strictures might represent recurrent PSC (rPSC). To estimate the risk factors for post-OLT non-anastomotic bile duct strictures in PSC patients and to find their possible etiology, we performed magnetic resonance cholangiography (MRC) and angiography (MRA) in all PSC patients who had undergone OLT and were alive (median follow-up 6.4 years, range 1.4-15.2 years). This group of PSC patients was compared to a group of 45 non-PSC patients who had also undergone OLT. A logistic regression analysis was performed to find predictors of rPSC. Bile duct strictures were found in 19/49 PSC patients and in 4/45 non-PSC patients (P = 0.001). In the PSC group nine patients without other possible explanations for bile duct strictures than rPSC were identified, i.e., the estimated risk of rPSC was 9/49 (18%); surprisingly similar changes were also seen in one patient without a pre-transplant PSC diagnosis. Severe liver disease due to rPSC was seen in 4/9 patients (one patient died and three are being evaluated for re-OLT). Steroid-resistant rejection was the only significant predictor for rPSC. In conclusion, our study shows that by the use of MRC we found more bile duct strictures in PSC patients post-OLT compared to controls and that steroid-resistant rejections was a predictor of such changes.
原发性硬化性胆管炎（PSC）是原位肝移植（OLT）公认的适应证，但OLT术后胆管狭窄会使这些患者的预后复杂化。这些狭窄可能代表复发性PSC（rPSC）。为了评估PSC患者OLT术后非吻合口胆管狭窄的危险因素并找出其可能的病因，我们对所有接受OLT且存活的PSC患者（中位随访6.4年，范围1.4 - 15.2年）进行了磁共振胆管造影（MRC）和血管造影（MRA）。将这组PSC患者与另一组同样接受OLT的45例非PSC患者进行比较。进行逻辑回归分析以找出rPSC的预测因素。在49例PSC患者中有19例发现胆管狭窄，在45例非PSC患者中有4例发现胆管狭窄（P = 0.001）。在PSC组中，有9例患者除rPSC外没有其他可能导致胆管狭窄的原因，即rPSC的估计风险为9/49（18%）；令人惊讶的是，在1例移植前未诊断为PSC的患者中也观察到了类似变化。9例患者中有4例因rPSC出现严重肝病（1例患者死亡，3例正在评估再次OLT）。激素抵抗性排斥是rPSC唯一的显著预测因素。总之，我们的研究表明，通过使用MRC，我们发现与对照组相比，PSC患者OLT术后胆管狭窄更多，且激素抵抗性排斥是此类变化的一个预测因素。
