Recurrence of primary sclerosing cholangitis after liver transplantation

Primary sclerosing cholangitis (PSC) is a progressive inflammatory disease of unknown etiology affecting the bile ducts, leading to fibrosis and eventually cirrhosis in most patients. Liver transplantation is the only effective therapy for PSC patients with end-stage liver disease. As a result of increasing number of patients transplanted for PSC, recurrent PSC has become an important condition negatively affecting graft survival and perhaps patient survival. The difficulty of diagnosing recurrent PSC in the allograft is compounded several fold due to a variety of insults seen exclusively after transplantation which may result in biliary stricture. Identification of risk factors for recurrent PSC is important because it may potentially alter the management of patients after transplantation, and might offer clues to the pathogenesis of PSC. As for PSC in the native liver, treatment options are limited for recurrent PSC. For these important entities affecting PSC patients after liver transplantation, we review the current published data on epidemiology, diagnostic criteria, risk factors, graft and patient survival, and treatment of recurrent PSC.