Journal ArticleDOI
Value of brush cytology for optimal timing of liver transplantation in primary sclerosing cholangitis.
TLDR
The value of surveillance for dysplasia using brush cytology, to determine the optimal timing of liver transplantation in primary sclerosing cholangitis, is investigated.Abstract:
Background and Aims
Primary sclerosing cholangitis (PSC) is associated with a high risk of cholangiocarcinoma (CCA). Here we investigated the value of surveillance for dysplasia using brush cytology, to determine the optimal timing of liver transplantation in PSC. We compared our preoperative findings, with the final explanted liver histopathology.
Methods
126 consecutive patients were transplanted for PSC from 1984-2012. Patients were divided into two groups: symptomatic (n = 91), and asymptomatic (n = 35).
Results
Brush cytology was available for 101 patients; 66 symptomatic and 35 asymptomatic. Suspicious cytological findings were found in 9 patients (14%) in the symptomatic group and 17 (49%) in the asymptomatic group. DNA flow cytometry was available for 49 patients (25 symptomatic, 24 asymptomatic), with aneuploidy detected in six patients (24%) in the symptomatic group and 15 (63%) in the asymptomatic group. Explanted liver histology showed biliary dysplasia or cholangiocarcinoma in 11 symptomatic patients (12%) and 15 asymptomatic patients (43%). A combination of cytological and DNA flow cytometry findings resulted in a test sensitivity of 68%, with a specificity of 86%. Ten-year survival in the asymptomatic group was 91%.
Conclusions
Dysplasia surveillance using brush specimens may help to select those patients likely to benefit from early liver transplantation. It remains unclear as to whether surveillance with brush cytology improves long-term survival, but there is presently no better method with which to predict transplantation timing.
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Citations
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Journal ArticleDOI
Anatomical, histomorphological and molecular classification of cholangiocarcinoma.
Timothy J. Kendall,Joanne Verheij,Eugenio Gaudio,Matthias Evert,Maria Guido,Benjamin Goeppert,Guido Carpino +6 more
TL;DR: A main challenge in diagnosing cholangiocarcinoma is the fact that tumour tissue for histological examination is difficult to obtain, a major clinical obstacle is the establishment of the correct diagnosis at a tumour stage that is amenable to surgery which still represents the only curable therapeutic option.
Journal ArticleDOI
EASL Clinical Practice Guidelines on Sclerosing Cholangitis.
Olivier Chazouillères,Ulrich Beuers,Annika Bergquist,Tom H. Karlsen,Cynthia Levy,Marianne Samyn,Christoph Schramm,Michael Trauner +7 more
TL;DR: Karlsen et al. as mentioned in this paper presented a comprehensive review of the causes of sclerosing cholangitis in adults and children, focusing on secondary causes, and provided guidance on diagnostic methods, prognostic assessment, early detection of complications, optimal care pathways and therapeutic (pharmacological, endoscopic or surgical) options.
Journal ArticleDOI
Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis (PSC): a Comprehensive Review
Junmin Song,Junmin Song,Yang Li,Christopher L. Bowlus,Guo-Xiang Yang,Patrick S.C. Leung,M. Eric Gershwin +6 more
TL;DR: More attention should be paid to PSC patients presenting with an abrupt aggravation of jaundice, pain, fatigue, pruritus, weight loss, or worsening liver biochemistries, in particular within the first year after PSC diagnosis.
Journal ArticleDOI
The role of magnetic resonance imaging and endoscopic retrograde cholangiography in the evaluation of disease activity and severity in primary sclerosing cholangitis.
Andrea Tenca,Harri Mustonen,Kati Lind,Eila Lantto,Kaija-Leena Kolho,Sonja Boyd,Johanna Arola,Kalle Jokelainen,Martti Färkkilä +8 more
TL;DR: Endoscopic retrograde cholangiography has been considered the gold standard for the diagnosis and follow-up of primary sclerosing cholangsitis, but it has been replaced by less invasive magnetic resonance imaging and cholANGiopancreatography, but the role of these two techniques in the evaluation of disease activity and severity needs to be elucidated.
Journal ArticleDOI
Graft glycocalyx degradation in human liver transplantation.
Arie Passov,Alexey Schramko,Heikki Mäkisalo,Arno Nordin,Sture Andersson,Eero Pesonen,Minna Ilmakunnas +6 more
TL;DR: In this paper, a human liver transplantation was studied in human liver, and the results showed that syndecan-1, heparan sulfate and chondroitin sulfate were taken up by the graft during reperfusion.
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Journal ArticleDOI
Primary sclerosing cholangitis
TL;DR: The role of environmental factors in generation of lymphocytes that are postulated to be retargeted, deleteriously, to the biliary tree has been investigated in this paper.