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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2023; 15(8): 939-953
Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.939
Liver transplant in primary sclerosing cholangitis: Current trends and future directions
Yash R Shah, Natalia Nombera-Aznaran, David Guevara-Lazo, Ernesto Calderon-Martinez, Angad Tiwari, SriLakshmiDevi Kanumilli, Purva Shah, Bhanu Siva Mohan Pinnam, Hassam Ali, Dushyant Singh Dahiya
Yash R Shah, Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI 48341, United States
Natalia Nombera-Aznaran, David Guevara-Lazo, Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
Ernesto Calderon-Martinez, Department of Internal Medicine, Universidad Nacional Autonoma de Mexico, Ciudad De Mexico 04510, Mexico
Angad Tiwari, Department of Internal Medicine, Maharani Laxmi Bai Medical College, Jhansi 284001, India
SriLakshmiDevi Kanumilli, Department of Internal Medicine, GSL Medical College, Rajamahendravaram 533296, India
Purva Shah, Department of Postgraduate Education, Harvard Medical School, Boston, MA 02115, United States
Bhanu Siva Mohan Pinnam, Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
Hassam Ali, Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
Author contributions: Shah YR, Nombera-Aznaran N, Ali H, and Dahiya DS contributed to conception and design; Shah YR, and Dahiya DS contributed to administrative support; Shah YR, Nombera-Aznaran N, Ali H, and Dahiya DS contributed to provision, collection, and assembly of data; Shah YR, Guevara-Lazo D, Calderon-Martinez E, Nombera-Aznaran N, Tiwari A, Kanumilli S, and Dahiya DS contributed to review of literature and drafting the manuscript; Shah YR, Dahiya DS, Shah P, Pinnam BSM, and Ali H contributed to revision of key components of the manuscript and final approval of manuscript; Shah YR, Guevara-Lazo D, Calderon-Martinez E, Nombera-Aznaran N, Tiwari A, Kanumilli S, Shah P, Pinnam BSM, Ali H and Dahiya DS are accountable for all aspects of the work.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dushyant Singh Dahiya, MD, Doctor, Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, No. 2000 Olathe Blvd, Kansas City, KS 66160, United States. dush.dahiya@gmail.com
Received: May 15, 2023
Peer-review started: May 15, 2023
First decision: July 10, 2023
Revised: July 23, 2023
Accepted: August 11, 2023
Article in press: August 11, 2023
Published online: August 27, 2023
Processing time: 99 Days and 7.5 Hours
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.