Liver transplantation for primary sclerosing cholangitis (PSC) can be complicated by recurrence of PSC (rPSC). This may compromise graft survival but the effect on patient survival is less clear. We investigated the effect of post-transplant rPSC on graft and patient survival in a large European cohort. Registry data from the European Liver Transplant Registry regarding all first transplants for PSC between 1980 and 2015 were supplemented with detailed data on rPSC from 48 out of 138 contributing transplant centres, involving 1,549 patients. Bayesian proportional hazards models were used to investigate the impact of rPSC and other covariates on patient and graft survival. Recurrence of PSC was diagnosed in 259 patients (16.7%) after a median follow-up of 5.0 years (quantile 2.5%-97.5%: 0.4-18.5), with a significant negative impact on both graft (HR 6.7; 95% CI 4.9-9.1) and patient survival (HR 2.3; 95% CI 1.5-3.3). Patients with rPSC underwent significantly more re-transplants than those without rPSC (OR 3.6, 95% CI 2.7-4.8). PSC recurrence has a negative impact on both graft and patient survival, independent of transplant-related covariates. Recurrence of PSC leads to higher number of re-transplantations and a 33% decrease in 10-year graft survival.

Abdominal Transplantation Surgery University Hospitals Leuven Leuven Belgium

Centre Hépatobiliaire AP HP Hôpital Paul Brousse Université Paris Saclay Villejuif France

Centre of Cardiovascular Surgery and Transplantations Brno Czech Republic

Department of Biostatistics Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

Department of Gastroenterology and Hepatology Erasmus MC Transplant Institute Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

Department of Gastroenterology and Hepatology University of Groningen and University Medical Centre Groningen Groningen The Netherlands

Department of General and Transplant Surgery University Hospital Essen Essen Germany

Department of General Visceral and Transplant Surgery Hannover Medical School Hannover Germany

Department of Hepatogastroenterology Institut Klinické Experimentální Medicíny Prague Czech Republic

Department of Surgery Division of Hepatopancreaticobiliary and Transplant Surgery Erasmus MC Transplant Institute Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands

Division of Transplantation Surgery Karolinska University Hospital Stockholm Sweden

Liver Transplantation Center Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino Turin Italy

Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health Royal Free Hospital London UK

Transpl Int. 2021 Oct;34(10):1754-1755. doi: 10.1111/tri.14014. PubMed

Zobrazit více v PubMed

Hirschfield GM, Karlsen TH, Lindor KD, Adams DH. Primary sclerosing cholangitis. Lancet 2013; 382: 1587. PubMed

Ponsioen CY, Vrouenraets SM, Prawirodirdjo W, et al. Natural history of primary sclerosing cholangitis and prognostic value of cholangiography in a Dutch population. Gut 2002; 51: 562. PubMed PMC

Karlsen TH, Folseraas T, Thorburn D, Vesterhus M. Primary sclerosing cholangitis ‐ a comprehensive review. J Hepatol 2017; 67: 1298. PubMed

Boonstra K, Weersma RK, van Erpecum KJ , et al. Population‐based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology 2013; 58: 2045. PubMed

Lindkvist B, Benito de Valle M, Gullberg B, Bjornsson E. Incidence and prevalence of primary sclerosing cholangitis in a defined adult population in Sweden. Hepatology 2010; 52: 571. PubMed

Bambha K, Kim WR, Talwalkar J, et al. Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. Gastroenterology 2003; 125: 1364. PubMed

Goet JC, Hansen BE, Tieleman M, et al. Current policy for allocation of donor livers in the Netherlands advantages primary sclerosing cholangitis patients on the liver transplantation waiting list‐a retrospective study. Transpl Int 2018; 31: 590. PubMed

Ravikumar R, Tsochatzis E, Jose S, et al. Risk factors for recurrent primary sclerosing cholangitis after liver transplantation. J Hepatol 2015; 63: 1139. PubMed

Alabraba E, Nightingale P, Gunson B, et al. A re‐evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts. Liver Transpl 2009; 15: 330. PubMed

Graziadei IW, Wiesner RH, Batts KP, et al. Recurrence of primary sclerosing cholangitis following liver transplantation. Hepatology 1999; 29: 1050. PubMed

Cholongitas E, Shusang V, Papatheodoridis GV, et al. Risk factors for recurrence of primary sclerosing cholangitis after liver transplantation. Liver Transpl 2008; 14: 138. PubMed

Alexander J, Lord JD, Yeh MM, Cuevas C, Bakthavatsalam R, Kowdley KV. Risk factors for recurrence of primary sclerosing cholangitis after liver transplantation. Liver Transpl 2008; 14: 245. PubMed

Lindstrom L, Jorgensen KK, Boberg KM, et al. Risk factors and prognosis for recurrent primary sclerosing cholangitis after liver transplantation: a Nordic Multicentre Study. Scand J Gastroenterol 2018; 53: 297. PubMed

Visseren T, Darwish MS. Recurrence of primary sclerosing cholangitis, primary biliary cholangitis and auto‐immune hepatitis after liver transplantation. Best Pract Res Clin Gastroenterol 2017; 31: 187. PubMed

Dekkers N, Westerouen van Meeteren M, Wolterbeek R, et al. Does mucosal inflammation drive recurrence of primary sclerosing cholangitis in liver transplantion recipients with ulcerative colitis? Dig Liver Dis 2020; 52: 528. PubMed

Erler NS, Rizopoulos D, Jaddoe VW, Franco OH, Lesaffre EM. Bayesian imputation of time‐varying covariates in linear mixed models. Stat Methods Med Res 2019; 28: 555. PubMed PMC

Erler NS, Rizopoulos D, JointAI LEM. JointAI: Joint Analysis and Imputation of Incomplete Data in R. 2019; arXiv e‐prints, arXiv:1907.10867.

Egawa H, Ueda Y, Ichida T, et al. Risk factors for recurrence of primary sclerosing cholangitis after living donor liver transplantation in Japanese registry. Am J Transplant 2011; 11: 518. PubMed

Moncrief KJ, Savu A, Ma MM, Bain VG, Wong WW, Tandon P. The natural history of inflammatory bowel disease and primary sclerosing cholangitis after liver transplantation–a single‐centre experience. Can J Gastroenterol 2010; 24: 40. PubMed PMC

Campsen J, Zimmerman MA, Trotter JF, et al. Clinically recurrent primary sclerosing cholangitis following liver transplantation: a time course. Liver Transpl 2008; 14: 181. PubMed

Goss JA, Shackleton CR, Farmer DG, et al. Orthotopic liver transplantation for primary sclerosing cholangitis. A 12‐year single center experience. Ann Surg 1997; 225: 472. PubMed PMC

Khettry U, Keaveny A, Goldar‐Najafi A, et al. Liver transplantation for primary sclerosing cholangitis: a long‐term clinicopathologic study. Hum Pathol 2003; 34: 1127. PubMed

Hildebrand T, Pannicke N, Dechene A, et al. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: A retrospective multicenter analysis. Liver Transpl 2016; 22: 42. PubMed

Burra P, Senzolo M, Adam R, et al. Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transplant 2010; 10: 138. PubMed

Germani G, Zeni N, Zanetto A, et al. Influence of donor and recipient gender on liver transplantation outcomes in Europe. Liver Int 2020; 40: 1961. PubMed

Haldar D, Kern B, Hodson J, et al. Outcomes of liver transplantation for non‐alcoholic steatohepatitis: A European Liver Transplant Registry study. J Hepatol 2019; 71: 313. PubMed PMC

Holmer M, Melum E, Isoniemi H, et al. Nonalcoholic fatty liver disease is an increasing indication for liver transplantation in the Nordic countries. Liver Int 2018; 38: 2082. PubMed

Berenguer M, Di Maira T, Baumann U, et al. Characteristics, trends and outcomes of liver transplantation for primary sclerosing cholangitis in female vs male patients: An analysis from the European Liver Transplant Registry. Transplantation 2020. [Epub ahead of print]. PubMed

Boonstra K, Beuers U, Ponsioen CY. Epidemiology of primary sclerosing cholangitis and primary biliary cirrhosis: a systematic review. J Hepatol 2012; 56: 1181. PubMed

Kootstra G, Daemen JH, Oomen AP. Categories of non‐heart‐beating donors. Transplant Proc. 1995; 27: 2893–2894. PubMed

Trivedi PJ, Scalera I, Slaney E, et al. Clinical outcomes of donation after circulatory death liver transplantation in primary sclerosing cholangitis. J Hepatol 2017; 67: 957. PubMed

Nemes B, Gaman G, Polak WG, et al. Extended‐criteria donors in liver transplantation Part II: reviewing the impact of extended‐criteria donors on the complications and outcomes of liver transplantation. Expert Rev Gastroenterol Hepatol 2016; 10: 841. PubMed

Ziogas IA, Alexopoulos SP, Matsuoka LK, et al. Living vs deceased donor liver transplantation in cholestatic liver disease: An analysis of the OPTN database. Clin Transplant 2020; 34: e14031. PubMed

Steenstraten IC, Sebib Korkmaz K, Trivedi PJ, et al. Systematic review with meta‐analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation. Aliment Pharmacol Ther 2019; 49: 636. PubMed PMC

Trivedi PJ, Reece J, Laing RW, et al. The impact of ileal pouch‐anal anastomosis on graft survival following liver transplantation for primary sclerosing cholangitis. Aliment Pharmacol Ther 2018; 48: 322. PubMed

Karam V, Gunson B, Roggen F, et al. Quality control of the European Liver Transplant Registry: results of audit visits to the contributing centers. Transplantation 2003; 75: 2167. PubMed

Adam R, Karam V, Cailliez V, et al. 2018 annual report of the european liver transplant registry (ELTR) ‐ 50‐year evolution of liver transplantation. Transpl Int 2018; 31: 1293. PubMed