Liver transplant in primary sclerosing cholangitis: Current trends and future directions

Abstract

Primary sclerosing cholangitis (PSC) is a chronic and progressive immune-mediated cholangiopathy causing biliary tree inflammation and scarring, leading to liver cirrhosis and end-stage liver disease. Diagnosis of PSC is challenging due to its nonspecific symptoms and overlap with other liver diseases. Despite the rising incidence of PSC, there is no proven medical therapy that can alter the natural history of the disease. While liver transplantation (LT) is the most effective approach for managing advanced liver disease caused by PSC, post-transplantation recurrence of PSC remains a challenge. Therefore, ongoing research aims to develop better therapies for PSC, and continued efforts are necessary to improve outcomes for patients with PSC. This article provides an overview of PSC’s pathogenesis, clinical presentation, and management options, including LT trends and future aspects. It also highlights the need for improved therapeutic options and ethical considerations in providing equitable access to LT for patients with PSC. Additionally, the impact of liver transplant on the quality of life and psychological outcomes of patients with PSC is discussed. Ongoing research into PSC’s pathogenesis and post-transplant recurrence is crucial for improved understanding of the disease and more effective treatment options.

Keywords: Primary sclerosing cholangitis; Liver transplantation; Management; Psychosocial outcomes; Pathogenesis

Core Tip: Despite recent advancements in the field of hepatology, therapeutic options for the medical management of primary sclerosing cholangitis (PSC) are limited. Liver transplantation (LT) remains the primary treatment for patients with end stage liver disease (ESLD) secondary to PSC. Both deceased donor liver transplant and living donor liver transplant have demonstrated successful outcomes in patients with ESLD. Psychosocial patient factors also play a significant role in the outcome LT. Addressing ethical issues is crucial to ensure healthcare equity. Recent developments in digital technology and stem cell therapy suggest a promising future for LT in PSC.