Recurrence of primary sclerosing cholangitis after liver transplantation: A single center data. (March 2023)

• Record Type: Journal Article
• Authors: Catanzaro, E.; Cazzagon, N.; Floreani, A.; Senzolo, M.; Germani, G.; Zanetto, A.; Russo, F.P.; Gringeri, E.; Cillo, U.; Burra, P.; Gambato, M.
• Is Part Of: Digestive and liver disease. Volume 55(2023)Supplement 1
• Page Start: S60
• Publication Date: 2023-03
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2023.01.117
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract : Introduction and Aim of the Study: Recurrence of primary sclerosing cholangitis (rPSC) after liver transplantation (LT) is a significant concern without any possibility of prevention. This study aimed to analyze the disease recurrence and long-term outcome after LT in a single center and investigate potentially modifiable risk factors. Materials and Methods: We performed a retrospective analysis of patients who underwent a first LT for PSC, using demographic and clinical data before and after LT and donor features. Only patients with at least one-year post-transplant follow-up were included. Results: Thirty-three patients who underwent LT for PSC between 1993 and 2021 were included. Median age at LT was 44 years (31.3–56.7), 52% were female and 73% had inflammatory bowel disease (IBD) (73%). Twenty-three patients underwent LT for decompensated cirrhosis (70%) 9 for recurrent cholangitis (27%) and 1 for perihilar cholangiocarcinoma (CCA) (3%). Median donor age was 52 years (26.5-68.6); median cold ischemia time (CIT) was 8 hours. Nine patients (27%) developed rPSC during a median follow-up of 60 months, with no significant difference across recipient gender and age. Longer CIT (p=0.0260) and female donor gender (p=0.049) were associated with the risk of rPSC, while donor age was not. An association between IBD reactivation after LT and a higher risk of rPSC was found (p=0.005). Performing biliodigestive anastomosis at LT was associated with a higher risk of recurrence (p=0.019). We observed a graft survival of 94%, 86%, and 74% and patient survival of 97%, 89%, and 77% at 1, 5, and 10 years after LT, respectively, with no significant differences in rPSC and no rPSC groups. Conclusions: The identification of predictive factors for rPSC is challenging. Some donor features could increase rPSC risk. IBD reactivation might have a pathogenic role in rPSC. The use of biliodigestive anastomosis might influence recurrence development. In our cohort, PSC did not affect patient and graft survival.