Waitlist mortality in primary sclerosing cholangitis and bacterial cholangitis

The latest issue of Liver Transplantation investigates the risk of waitlist mortality in patients with primary sclerosing cholangitis and bacterial cholangitis.

Patients with primary sclerosing cholangitis are at increased risk for bacterial cholangitis because of biliary strictures and bile stasis.

A subset of primary sclerosing cholangitis patients suffer from repeated episodes of bacterial cholangitis, which can lead to frequent hospitalizations and impaired quality of life.

Although waitlist candidates with primary sclerosing cholangitis 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.

Dr David Goldberg and colleagues performed a retrospective cohort study of all adult waitlist candidates with primary sclerosing cholangitis who were listed for initial transplantation between 2002 and 2012.

39% of the patients had a history of bacterial cholangitis

Liver Transplantation

During this period, 171 primary sclerosing cholangitis patients were waitlisted for initial transplantation.

Before waitlisting, 39% of the patients had a history of bacterial cholangitis, whereas 28% of the patients with at least 1 Model for End-Stage Liver Disease update experienced cholangitis on the waitlist.

During follow-up, 18% patients were removed from the waitlist for death or clinical deterioration, with 47% developing cholangiocarcinoma.

Overall, 15% of waitlist candidates who ever had an episode of cholangitis were removed for death or clinical deterioration, whereas 20% of candidates without cholangitis were removed.

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.

Dr Goldberg's team commented, "In summary, waitlist transplant candidates with primary sclerosing cholangitis 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."