| Risk of waitlist mortality in patients with primary sclerosing cholangitis and bacterial cholangitis. | |
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MedLine Citation:
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PMID: 23213009 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Patients with primary sclerosing cholangitis (PSC) are at increased risk of bacterial cholangitis due to biliary strictures and bile stasis. A subset of PSC patients suffer from repeated episodes of bacterial cholangitis, leading to frequent hospitalizations and impaired quality of life. Although PSC waitlist candidates with bacterial cholangitis frequently receive exception points, and/or are referred for living donor transplantation, the impact of bacterial cholangitis on waitlist mortality is unknown. We performed a retrospective cohort study of all adult PSC waitlist candidates listed for initial transplantation from February 27, 2002 to June 1, 2012 at the University of Pennsylvania and the University of Colorado-Denver. Over this period, 171 PSC patients were waitlisted for initial transplantation. Prior to waitlisting, 38.6% (66/171) of patients had a history of bacterial cholangitis, while 28.0% (44/157) of those with at least one MELD update experienced cholangitis on the waitlist. During follow-up, 30 (17.5%) patients were removed from the waitlist for death or clinical deterioration, with 46.7% (14/30) developing cholangiocarcinoma. Overall, 12/82 (14.6%) waitlist candidates who ever had an episode of cholangitis were removed for death or clinical deterioration, compared with 18/89 (20.2%) without cholangitis (P=0.34 comparing two groups). No patients were removed due to bacterial cholangitis. In multivariable competing risk models, a history of bacterial cholangitis was not associated with an increased risk of waitlist removal for death or clinical deterioration (subhazard ratio=0.67; 95% CI: 0.65-0.70, P<0.001). In summary, PSC waitlist transplant candidates with bacterial cholangitis do not have an increased risk of waitlist mortality. The data call into question the systematic granting of exception points or referral for living donor transplantation due to a perceived risk of increased waitlist mortality. © 2012 American Association for the Study of Liver Diseases. |
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Authors:
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David S Goldberg; Amanda Camp; Alvaro Martinez-Camacho; Lisa Forman; Brett Fortune; K Rajender Reddy |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-5 |
Journal Detail:
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Title: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Volume: - ISSN: 1527-6473 ISO Abbreviation: Liver Transpl. Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-5 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100909185 Medline TA: Liver Transpl Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 American Association for the Study of Liver Diseases. |
Affiliation:
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Division of Gastroenterology, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania. david.goldberg@uphs.upenn.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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