Risk of waitlist mortality in patients with primary sclerosing cholangitis and bacterial cholangitis
Open accessAbstract
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.
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Transplant candidates with PSC and bacterial cholangitis had no increased risk of waitlist mortality in a study from 2 US transplant centres.
“However, transplant candidates with PSC and bacterial cholangitis had no increased risk of waitlist mortality in a study from 2 US transplant centres.244”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [244]
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- Authors
- Goldberg, D. S., Camp, A., Martinez-Camacho, A., Forman, L., Fortune, B., & Reddy, R. K.
- Affiliations
- University of Pennsylvania (US)
- University of Colorado Denver (US)
- Yale New Haven Hospital (US)
- Corresponding author
- Goldberg, David S.
- Venue
- Liver Transplantation
- Published
- 2013-03
- Volume
- 19
- Issue
- 3
- Pages
- 250-258
- ISSN
- 1527-6465 (ISSN-L)
- PMC
- PMC3600057
- OpenAlex
- W1559553970
- Cited by
- 58
- References
- 17
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 7 · 2016: 4 · 2015: 7 · 2014: 3 · 2013: 6
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Liver Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1-F32-)
- National Institute of Diabetes and Digestive and Kidney Diseases (F32 1-F32-DK-089694-01, F32DK089694)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- primary sclerosing cholangitis, bacterial cholangitis, waitlist mortality, living donor liver transplantation, cholangiocarcinoma, competing risks, MELD score
- MeSH terms
- Adult, Cholangitis, Colorado, Female, Humans, Male, Middle Aged, Pennsylvania, Recurrence, Retrospective Studies, Risk Factors, Time Factors, Waiting Lists, Cholangitis, Sclerosing, Multivariate Analysis, Proportional Hazards Models, Liver Transplantation, Risk Assessment, Patient Selection
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