Caroli's disease and orthotopic liver transplantation

Shahid - Habib, Obaid Shakil, Osvaldo F. Couto, Anthony J. Demetris, John J. Fung, Amadeo Marcos, Kapil Chopra

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Caroli's disease is a rare congenital hepatic disease, characterized by segmental dilatation of the biliary tree. Patients who have recurrent bouts of biliary infection, particularly those with complications related to portal hypertension, may require orthotopic liver transplantation (OLT). Few case reports have described the outcome of OLT in patients with Caroli's disease and to date there is no large series reported in the literature. We retrospectively analyzed the outcome of OLT in patients with Caroli's disease who underwent OLT between 1982 and 2002 at Starzl Transplantation Institute, University of Pittsburgh. Patients were identified and data was collected by computerized search of the electronic database system. All patients had confirmation of diagnosis by histopathology of explanted liver. A total of 33 patients with Caroli's disease were listed for liver transplantation, 3 of whom were excluded, as they were not transplanted. A total of 90% had signs of hepatic decompensation at the time of OLT. Median posttransplantation follow-up was 7.7 yr. Short-term graft and patient survival at 1 month was 83% and 86%, whereas overall long-term graft survival rates at 1, 5, and 10 yr were 73%, 62%, and 53%, respectively, and patient survival rates were 76%, 65%, and 56%, respectively. Long-term outcome in patients who survived the first year after transplantation was significantly better. Their survival rate at 5 and 10 yr was 90% and 78%. On univariable analysis, recipient age, donor male gender, coexistent congenital hepatic fibrosis, and re-OLT were associated with poor patient survival. Eight patients were retransplanted, 3 of whom had primary nonfunction. A total of 13 patients died; the most common cause of death being sepsis and cardiovascular complications. Patients who died of sepsis had cholangitis pre-OLT. In conclusion, OLT is a form of curative and life-saving therapy in patients with Caroli's disease, especially in those with decompensated liver disease. Overall survival is better with liver transplantation and is comparable with the survival of recipients who undergo OLT for other etiologies of chronic liver disease. Survival was poor in patients with congenital hepatic fibrosis (Caroli's syndrome) and in those who had cholangitis at the time OLT.

Original languageEnglish (US)
Pages (from-to)416-421
Number of pages6
JournalLiver Transplantation
Volume12
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

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Caroli Disease
Liver Transplantation
Cholangitis
Survival
Survival Rate
Graft Survival
Liver Diseases
Liver
Sepsis
Transplantation

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Habib, S. ., Shakil, O., Couto, O. F., Demetris, A. J., Fung, J. J., Marcos, A., & Chopra, K. (2006). Caroli's disease and orthotopic liver transplantation. Liver Transplantation, 12(3), 416-421. https://doi.org/10.1002/lt.20719

Caroli's disease and orthotopic liver transplantation. / Habib, Shahid -; Shakil, Obaid; Couto, Osvaldo F.; Demetris, Anthony J.; Fung, John J.; Marcos, Amadeo; Chopra, Kapil.

In: Liver Transplantation, Vol. 12, No. 3, 03.2006, p. 416-421.

Research output: Contribution to journalArticle

Habib, S, Shakil, O, Couto, OF, Demetris, AJ, Fung, JJ, Marcos, A & Chopra, K 2006, 'Caroli's disease and orthotopic liver transplantation', Liver Transplantation, vol. 12, no. 3, pp. 416-421. https://doi.org/10.1002/lt.20719
Habib S, Shakil O, Couto OF, Demetris AJ, Fung JJ, Marcos A et al. Caroli's disease and orthotopic liver transplantation. Liver Transplantation. 2006 Mar;12(3):416-421. https://doi.org/10.1002/lt.20719
Habib, Shahid - ; Shakil, Obaid ; Couto, Osvaldo F. ; Demetris, Anthony J. ; Fung, John J. ; Marcos, Amadeo ; Chopra, Kapil. / Caroli's disease and orthotopic liver transplantation. In: Liver Transplantation. 2006 ; Vol. 12, No. 3. pp. 416-421.
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abstract = "Caroli's disease is a rare congenital hepatic disease, characterized by segmental dilatation of the biliary tree. Patients who have recurrent bouts of biliary infection, particularly those with complications related to portal hypertension, may require orthotopic liver transplantation (OLT). Few case reports have described the outcome of OLT in patients with Caroli's disease and to date there is no large series reported in the literature. We retrospectively analyzed the outcome of OLT in patients with Caroli's disease who underwent OLT between 1982 and 2002 at Starzl Transplantation Institute, University of Pittsburgh. Patients were identified and data was collected by computerized search of the electronic database system. All patients had confirmation of diagnosis by histopathology of explanted liver. A total of 33 patients with Caroli's disease were listed for liver transplantation, 3 of whom were excluded, as they were not transplanted. A total of 90{\%} had signs of hepatic decompensation at the time of OLT. Median posttransplantation follow-up was 7.7 yr. Short-term graft and patient survival at 1 month was 83{\%} and 86{\%}, whereas overall long-term graft survival rates at 1, 5, and 10 yr were 73{\%}, 62{\%}, and 53{\%}, respectively, and patient survival rates were 76{\%}, 65{\%}, and 56{\%}, respectively. Long-term outcome in patients who survived the first year after transplantation was significantly better. Their survival rate at 5 and 10 yr was 90{\%} and 78{\%}. On univariable analysis, recipient age, donor male gender, coexistent congenital hepatic fibrosis, and re-OLT were associated with poor patient survival. Eight patients were retransplanted, 3 of whom had primary nonfunction. A total of 13 patients died; the most common cause of death being sepsis and cardiovascular complications. Patients who died of sepsis had cholangitis pre-OLT. In conclusion, OLT is a form of curative and life-saving therapy in patients with Caroli's disease, especially in those with decompensated liver disease. Overall survival is better with liver transplantation and is comparable with the survival of recipients who undergo OLT for other etiologies of chronic liver disease. Survival was poor in patients with congenital hepatic fibrosis (Caroli's syndrome) and in those who had cholangitis at the time OLT.",
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