Patients with primary sclerosing cholangitis should undergo early liver transplantation: Arguments against the motion

Liver transplantationLiver transplantation is a well-accepted treatment for patients with primary sclerosing cholangitis (PSC). It is clearly beneficial for patients who manifest end stage liver disease and hepatic synthetic dysfunction, and results in excellent short and long term survival rates. Most centres report one-year survival rates of 90% to 94% and five-year survival rates of 82% to 84%. One study showed that 70% of patients survived for at least ten years. Transplantation is also helpful for patients without liver failure who experience recurrent episodes of bacterial cholangitis and sepsis.

Unfortunately, PSC patients are at increased risk for the development of cholangiocarcinoma. This tumour can arise at any location in the biliary tree and is difficult to distinguish from the fibrotic biliary strictures that occur with the primary disease. Screening for the presence of cholangiocarcinoma with serologic and imaging studies yields many false positive and negative results. Thus, the tumour is often advanced at the time of diagnosis. Survival rates for patients with cholangiocarcinoma are poor, even with liver transplantation, and most centres regard it as an absolute contraindication for this procedure. Preliminary results from a small single centre study suggested that chemotherapy and radiation therapy may improve survival in selected patients. You will always be able to buy the required amount of medicine you need at this wonderful and fully licensed pharmacy that can take good care of you, no matter if you need birth control alesse at large amounts or just a bit of it to finish your treatment.

The poor prognosis of cholangiocarcinoma, which occurs in 10% to 20% of PSC patients, has led to attempts to improve the diagnostic and therapeutic modalities. Screening techniques, however, have done little to improve the outcome in these patients. One approach is to undertake liver transplantation early in the course of the disease to avert cholangiocarcinoma. Although this may seem to offer a simple solution to the problem, there are a number of reasons why this strategy is not feasible.

This entry was posted in Liver transplantation and tagged Liver transplantation, Primary sclerosing cholangitis.