P0174 - On the Waiting List for Transplant: Recurrent Hospitalizations From Primary Sclerosing Cholangitis

Kara Devine, DO¹, Sarah Elrod, DO², Kavya Khota, MD², Matthew Still, DO, BS^3
1Abington Jefferson Hospital, Abington, PA; ²Jefferson Abington Hospital, Abington, PA; ³University of Cincinnati Medical Center, Cincinnati, OH

Introduction: This case describes the management of primary sclerosing cholangitis (PSC) in a patient who was hospitalized multiple times for recurrent exacerbations of symptoms, including pain, infection, pruritis, and stent failure.

Case Description/Methods: A 60-year-old male with a history of primary sclerosing cholangitis (PSC) presented with recurrent right upper quadrant pain and pruritus. He had undergone multiple stent exchanges in the past with temporary alleviation of symptoms (six ERCP procedures in 2023). His transaminases would fluctuate, but typically had an ALP of 1100-1200, AST 70-100, ALT 90-120, and total bilirubin 1.50-3.0. He was placed on the transplant list in early 2023 and continues to wait for a liver. To manage his pain and prevent recurrent infection he has both planned and emergent stent exchanges. He also undergoes scheduled therapeutic plasma exchange to manage his pruritus as an outpatient. Ultimately, the cure for his condition will be a liver transplant.

Discussion: Primary sclerosing cholangitis can be a difficult disease to symptomatically treat. While temporizing solutions are available, such as ERCP with stent placement and therapeutic plasma exchange, some patients will continue to suffer recurrence of symptoms despite repeated treatment and interventions. In these patients there is a burden on the patient due to the frequent admissions as well as the health care facility. Ultimately, the best treatment for this patient is a liver transplant. However, as seen in this patient, waiting on a viable donor can take a long period of time, prolonging the amount of time patients suffer from disease symptoms.


Disclosures:


Kara Devine, DO¹, Sarah Elrod, DO², Kavya Khota, MD², Matthew Still, DO, BS³. P0174 - On the Waiting List for Transplant: Recurrent Hospitalizations From Primary Sclerosing Cholangitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.