[Primary sclerosing cholangitis in Iceland 1992-2012].

BACKGROUND: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation that can lead to cirrhosis, end stage liver failure and liver transplantation. Known risk factors include inflammatory bowel diseases (IBD), mainly ulcerative colitis (UC). Highest reported incidence in an adult population is 1.2-1.3/100.000 in Norway and Sweden, where 60-76% have IBD. The aim of this study was to investigate epidemiology of PSC in Iceland in the years 1992 to 2012 and the patients outcomes. METHODS: A search for the diagnosis "cholangitis" (ICD-10, K83.0) was performed in the database for hospital records in Landspítali (The National University Hospital of Iceland, LSH) and Akureyri Hospital from 1992 to 2012. We also looked through all ERCP and MRCP imaging done in LSH in the same period along with a text search in both the hospital records and the pathology database for liver biopsies. Data on these patients was collected until the end of 2016. RESULTS: A total of 42 patient got the diagnosis PSC within the period. Median age at diagnosis was 34 years, 67% were male and 90% adults (≥18 years old). Mean incidence per year was 0.69/100.000. Overall 88% of patients had IBD, thereof 89% UC. Seven patients have been diagnosed with cancer, four with cancer in the bile ducts and one in the gallbladder. Within the study period a total of five patients died (12%), 51 months (median) from diagnosis and three from cholangiocarcinoma, 51 months (median) from diagnosis. Three patients (7%) underwent liver transplantation, one required a transplant two times. CONCLUSIONS: The incidence of PSC in Iceland turned out to be lower than in our neighbouring countries in Scandinavia. It is unclear if this is due to underdiagnosis or, more likely, that PSC is simply more uncommon in Iceland. Overall 7% underwent liver transplantation and 12% died within the study period, main cause of mortality being cholangiocarcinoma.

[Liver transplantation in Iceland: a retrospective study of indications and results]. / Lifrarígræðslur á Íslandi: afturskyggn rannsókn á ábendingum og árangri.

BACKGROUND/AIMS: Liver transplantation is an important treatment option for end-stage liver disease. Since liver transplantation is not performed in Iceland, patients are sent abroad for this procedure. The aim of this study was to investigate indications and results of liver transplantations for Icelandic patients. MATERIALS AND METHODS: The study was retrospective and included all patients in Iceland who had undergone liver transplantation from the first transplantation in 1984 to the end of 2012. Information was gathered from medical records. The study period was divided into three subperiods in order to evaluate changes in frequency of transplantation and survival. RESULTS: During the period, 45 liver transplantations, thereof five retransplantations, were performed. Of 40 patients 16 were males, 18 females, mean age 40 years. There were six children, 2 girls and 4 boys with an age range of 0.4-12 years. Number of transplantation per million inhabitants increased significantly (2.40 during 1984-1996; 5.18 during 1997-2006 and 8.90 during 2007-2013; p<0.01). The main indication for transplantation was cirrhosis with complications in 26 patients (65%), acute liver failure in 6 (15%), cirrhosis and hepatocellular carcinoma in three (8%), and hemangioendothelioma in two (5%). The most common underlying liver diseases were primary biliary cirrhosis in 8 (20%), autoimmune hepatitis in four (10%), alcoholic cirrhosis in three (7.5%) and primary sclerosing cholangitis in three (7.5%). The mean waiting time for transplantation was 5.9 months (median 3.2). Survial was 84% in one year and 63% in 5 years. Survival increased during the study period. CONCLUSIONS: The number of liver transplantations has increased significantly in recent years. Survival has improved and is comparable to survival in countries where liver transplantations are performed.

[Loco-regional therapy for liver malignancy in Iceland]. / Innaedalyfjagjof med slagaedastiflun: arangur stadbundinnar krabbameinsmedferdar a Islandi.

BACKGROUND AND AIMS: Transarterial chemoembolization (TACE) is a loco-regional therapy performed to treat tumors in the liver. The branch of the hepatic artery supplying the tumor is catheterized and a mixture of iodized oil, chemotherapeutic agents and PVA embolic materials infused. TACE is a palliative treatment of unresectable cancer in the liver but can also be employed as adjunctive therapy to liver resection and/or radiofrequency ablation. The procedure can in certain instances downstage the disease and provide a bridge to liver transplantation. The aim of this study was to evaluate outcome in patients that have undergone loco-regional therapy in Iceland and the frequency and severity of complications related to the procedure. MATERIAL AND METHODS: All Icelandic patients that had undergone TACE, transarterial chemotherapy or bland embolization of liver tumors between 1 May 2007 and 1 March 2011 were included in the study. RESULTS: Eighteen TACE, six transarterial chemotherapy treatments and two bland embolizations were performed on nine patients with hepatocellular carcinoma (HCC), and three patients with carcinoid metastases in the liver. Mean-survival of patients with HCC was 15.2 months. Survival of patients with carcinoid metastases was between 61 and 180 months. Complete response was achieved twice and partial response four times. The disease remained stable after eleven procedures but progressed after three procedures. Minor complications were diagnosed in 6 of 26 procedures and one major complication. No patient suffered from liver failure due to the procedure. Of the 9 HCC patients, 1 patient was on the liver transplant list before TACE and later underwent successful transplantation. Additionally, 3 of the remaining 8 patients were downstaged and put on to the transplant list.