| Contributors: |
Morelli, M. C.; Gambato, M.; Martini, S.; Carrai, P.; Toniutto, P.; Giannelli, V.; Donato, F.; Lenci, I.; Pasulo, L.; Mazzarelli, C.; Ferrarese, A.; Rendina, M.; Grieco, A.; Lanza, A. G.; Baroni, G. S.; De Maria, N.; Marenco, S.; Mameli, L.; Ponziani, F. R.; Vitale, G.; Burra, P.; Vigano, R.; Fornasiere, E.; Catanzaro, E.; Marrone, G.; Milana, M.; Calleri, A.; Scorzoni, C.; Frassanito, G.; Lionetti, R.; Dibenedetto, C. |
| Description: |
Background: Primary sclerosing cholangitis is a cholestatic disease with a low prevalence in Italy. Indications for liver transplantation and the time of listing are not stated. Aim: We performed a national survey to investigate the listing criteria, comorbidities, and outcomes. Methods: In April 2022, we surveyed liver transplantation in primary sclerosing cholangitis nationwide for the last 15 years. Results: From 2007 to 2021, 445 patients were included on waiting lists, and 411 had undergone liver transplants. The median age at transplantation was 46 years (males 63.9%); 262 patients (59%) presented an inflammatory bowel disease. Transplants increased over the years, from 1.8 % in 2007 to 3.0 % in 2021. Cholangitis (51%) and hepatic decompensation (45%) were the main indications for listing. The disease recurred in 81 patients (20%). Patient survival after the first transplant was 94 %, 86% and 84% at one, five, and ten years. Twenty-four died in the first year (50% surgical complications, 25% infections); 33 between one to five years (36% recurrence, 21% cholangiocarcinoma recurrence) and nine after five years (56% de novo cancer, 44% recurrence). Conclusions: Primary sclerosing cholangitis has been an increasing indication for transplantation in Italy. Cholangitis and decompensation were the main indications for listing. Recurrence and cancer were the leading causes of death. |