Primary sclerosing cholangitis has a number of treatment options—both medical and surgical. Which of the following statement(s) is/are true?

b. Biliary reconstruction with long-term transanastomotic stents can be useful in selected patients with focal strictures at the hepatic duct bifurcation 

d. Hepatic transplantation for primary sclerosing cholangitis can be associated with survival rates similar to other indications for transplantation

There is no known specific, effective medical therapy for primary sclerosing cholangitis. Although encouraging results from a prospective, randomized, placebo-controlled trial suggests that ursodeoxycholic acid significantly improves serum liver function tests and clinical symptoms. Because of the lack of effective medical therapy, an aggressive surgical approach is indicated for most symptomatic patients with primary sclerosing cholangitis. One surgical approach, in patients with a predominant stricture at the hepatic duct bifurcation, is resection of the bifurcation and long-term transhepatic stenting with silastic stents. Results in patients without established cirrhosis are excellent. However, in those patients with secondary biliary cirrhosis present before surgery, perioperative morbidity and mortality have been high and long-term results poor. Patients with established secondary biliary cirrhosis should be referred for hepatic transplantation. Recent reviews of the experience with hepatic transplantation for primary sclerosing cholangitis would suggest survival to be similar to those reported for hepatic transplantation for patients with any diagnosis.