Live donor liver transplantation for primary sclerosing cholangitis: is disease recurrence increased?

There is convincing evidence that primary sclerosing cholangitis (PSC) recurs after deceased donor liver transplantation with an incidence of about 20% after 5 years. This review summarizes data regarding recurrent disease in the setting of live donor liver transplantation.

End-stage liver disease secondary to PSC accounts for less than 3% of all live donor liver transplantations worldwide. Therefore, there are only few data regarding recurrent disease in this setting available, mainly from Japanese transplant centers. Based on these studies, however, only including a small number of patients, recurrent disease was diagnosed in 25-67% of transplant recipients after a mean follow-up of 34 months following transplantation. Cytomegalovirus infection in the early postoperative phase and biologically related donors were found to be statistically significant risk factors for disease recurrence. More than one third of patients with recurrent disease either died or developed graft failure.

These data suggest that patients with PSC undergoing live donor liver transplantation, especially with biologically related donors, may have a higher risk to develop recurrent disease compared with the deceased donor setting. However, this fact has to be interpreted with great caution, primarily due to the rather small number of patients. Further studies analyzing pooled data of all transplant centers performing live donor liver transplantations are needed to confirm these findings.