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

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