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Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary candidiasis.
[cholangiocarcinoma]
Candidiasis
is
commonly
observed
in
patients
with
primary
sclerosing
cholangitis
(
PSC
)
,
but
the
clinical
risk
factors
associated
with
its
presence
have
not
been
fully
investigated
.
In
this
study
,
we
aimed
to
analyse
the
incidence
,
risk
factors
,
and
transplantation-free
survival
in
primary
sclerosing
cholangitis
(
PSC
)
patients
with
persistent
biliary
candidiasis
.
We
retrospectively
analysed
patients
diagnosed
with
PSC
who
were
admitted
to
our
department
during
2002
to
2012
.
One
-
hundred
fifty
patients
whose
bile
cultures
were
tested
for
fungal
species
were
selected
,
and
their
clinical
and
laboratory
parameters
were
investigated
.
The
results
of
endoscopic
retrograde
cholangiography
(
ERC
)
and
bile
cultures
were
analysed
using
chart
reviews
.
The
cases
of
biliary
candidiasis
were
sub-classified
as
transient
or
persistent
.
Thirty
out
of
150
(
20
.
0
%
)
patients
had
biliary
candidiasis
.
Although
all
patients
demonstrated
comparable
baseline
characteristics
,
those
with
biliary
candidiasis
showed
significantly
reduced
transplantation-free
survival
(
p
<
0
.
0001
)
along
with
a
markedly
elevated
frequency
of
cholangiocarcinoma
(
CCA
)
(
p
=
0
.
04
)
.
The
patients
were
further
sub-classified
according
to
the
transient
(
15
/
30
)
or
persistent
(
15
/
30
)
nature
of
their
biliary
candidiasis
.
A
subgroup
analysis
showed
reduced
survival
with
a
greater
necessity
for
orthotopic
liver
transplantation
(
OLT
)
only
in
patients
with
persistence
of
Candida
(
p
=
0
.
007
)
.
The
survival
in
the
patients
with
transient
biliary
candidiasis
was
comparable
to
that
in
candidiasis-free
patients
.
In
a
multivariate
regression
analysis
that
included
Mayo
risk
score
(
MRS
)
,
sex
,
age
,
dominant
stenosis
,
inflammatory
bowel
disease
,
autoimmune
hepatitis
overlap
syndrome
,
and
number
of
times
ERC
was
performed
,
biliary
candidiasis
was
an
independent
risk
factor
for
reduced
survival
(
p
=
0
.
008
)
.
Risk
factors
associated
with
acquisition
of
biliary
candidiasis
were
age
at
PSC
diagnosis
and
number
of
ERCs
.
T
he
persistence
of
biliary
candidiasis
is
associated
with
markedly
reduced
transplantation-free
survival
in
PSC
patients
.
By
contrast
,
actuarial
survival
in
patients
with
transient
biliary
candidiasis
approaches
that
for
patients
without
any
evidence
of
biliary
candidiasis
.
Further
studies
on
the
treatment
of
persistent
biliary
candidiasis
in
patients
with
PSC
are
warranted
.
Diseases
Validation
Diseases presenting
"persistence of biliary candidiasis"
symptom
cholangiocarcinoma
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