FIBROUS AND OBLITERATIVE CHOLANGITIS IN LIVER ALLOGRAFTS - EVIDENCE OF RECURRENT PRIMARY SCLEROSING CHOLANGITIS

Fibroobliterative lesions and fibrous cholangitis are characteristic histological lesions of primary sclerosing cholangitis. To determine whether such lesions can be found in the liver allograft, and whether they represent recurrent disease, we reviewed all consecutive histological material taken at greater than 6 mo after transplantation in a 3-yr period from a series of 207 liver transplantations (22 with primary sclerosing cholangitis, 185 controls without primary sclerosing cholangitis). Because patients with primary sclerosing cholangitis have a biliary system reconstructed by means of a Roux loop, we compared the findings with those from a further control group of patients who had received a Roux loop for reasons other than primary sclerosing cholangitis. Of 22 patients receiving liver transplants for primary sclerosing cholangitis, 7 (32%) patients had biopsy specimens showing features of biliary obstruction, 6 (27%) showed fibrous cholangitis, and 3 (14%) showed classic fibroobliterative lesions. These findings compared with 3 (14%), 1 (5%) and 0 of 22 Roux controls, and 19 (10%), 4 (2%) and 0 of 185 controls without primary sclerosing cholangitis, respectively. The three patients with fibroobliterative lesions either had clinical episodes of cholangitis or had microorganisms in the large bile ducts. However, both biliary obstructive features and fibrous cholangitis were more common in primary sclerosing cholangitis, and fibroobliterative lesions were found only in patients who received transplants for primary sclerosing cholangitis, despite the presence of cholangitis and Roux loops in control patients. In conclusion, although some of these lesions could represent a secondary sclerosing cholangitis, our observations suggest that primary sclerosing cholangitis may recur in the liver allograft.