Assessment for liver transplantation in patients with primary sclerosing cholangitis

Recently three large studies have been presented in which the prognostic significance of clinical, laboratory and histological parameters measured early in the course of the disease was determined in primary sclerosing cholangitis patients. A different prognostic index was presented in each study. The aim of the present study was to evaluate these prognostic indices in a group of 37 patients with primary sclerosing cholangitis, assessed for liver transplantation. The results are compared to the outcome in the patients. At first referral, 12 patients were considered too healthy for transplantation and 17 were accepted for transplantation, six of whom died during the waiting time. Ten patients had cholangiocarcinoma or hepatocellular cancer. Albumin and bilirubin differed significantly between the patients accepted for transplantation and those considered too healthy. Only one prognostic index, presented by Dickson et al., could discriminate between "too healthy" and "in need of transplantation". However, the overlap between the groups was large, suggesting that this index may be of little or no help in the clinical situation with individual patients. Moreover, neither the prognostic index, nor any of the laboratory values could identify the patients with cancer. It is concluded that prognostic indicators have been found that may help to characterise primary sclerosing cholangitis patients. However, primary sclerosing cholangitis patients with an accompanying cholangiocarcinoma still cannot be identified.