Document Detail

Risk of waitlist mortality in patients with primary sclerosing cholangitis and bacterial cholangitis.
MedLine Citation:
PMID:  23213009     Owner:  NLM     Status:  MEDLINE    
Patients with primary sclerosing cholangitis (PSC) are at increased risk for bacterial cholangitis because of biliary strictures and bile stasis. A subset of PSC patients suffer from repeated episodes of bacterial cholangitis, which can lead to frequent hospitalizations and impaired quality of life. Although waitlist candidates with PSC and 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 waitlist candidates with PSC who were listed for initial transplantation between February 27, 2002 and June 1, 2012 at the University of Pennsylvania and the University of Colorado-Denver. During this period, 171 PSC patients were waitlisted for initial transplantation. Before waitlisting, 38.6% (66/171) of the patients had a history of bacterial cholangitis, whereas 28.0% (44/157) of the patients with at least 1 Model for End-Stage Liver Disease update experienced cholangitis on the waitlist. During follow-up, 30 patients (17.5%) were removed from the waitlist for death or clinical deterioration, with 46.7% (14/30) developing cholangiocarcinoma. Overall, 12 of the 82 waitlist candidates (14.6%) who ever had an episode of cholangitis were removed for death or clinical deterioration, whereas 18 of the 89 candidates (20.2%) without cholangitis were removed (P = 0.34 for a comparison of the 2 groups). No patients were removed because of bacterial cholangitis. In multivariate 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% confidence interval = 0.65-0.70, P < 0.001). In summary, waitlist transplant candidates with PSC and 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.
David S Goldberg; Amanda Camp; Alvaro Martinez-Camacho; Lisa Forman; Brett Fortune; K Rajender Reddy
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  19     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-15     Completed Date:  2013-09-03     Revised Date:  2014-05-29    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Association for the Study of Liver Diseases.
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MeSH Terms
Cholangitis / microbiology,  mortality*,  surgery*
Cholangitis, Sclerosing / mortality*,  surgery*
Liver Transplantation*
Middle Aged
Multivariate Analysis
Patient Selection
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Waiting Lists / mortality*
Grant Support
F32 1-F32-DK-089694-01/DK/NIDDK NIH HHS; F32 DK089694/DK/NIDDK NIH HHS
Comment In:
Liver Transpl. 2013 Mar;19(3):241-2   [PMID:  23447418 ]

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