A re-evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts

Abstract

Previously, we have found that the absence of the colon after liver transplantation (LT) protects the patient from recurrent primary sclerosing cholangitis (rPSC). As our previous observation has not been confirmed in other series, we have reviewed our cohort of patients grafted for primary sclerosing cholangitis (PSC) with greater numbers and longer follow-up to reassess the rate, consequences, and risk factors for rPSC. We collected data on patients who underwent LT for PSC between January 1986 and April 2006. Data were collected for cytomegalovirus status, inflammatory bowel disease status, time of colectomy, type of colectomy, donor-recipient gender mismatch, recipient sex, extended donor criteria (EDC), and donor risk index. Accepted criteria were used to diagnose rPSC. Of a total of 230 consecutive adult patients, 61 (27%) underwent colectomy pre-/peri-LT, and 54 (23.5%) developed rPSC at a median of 4.6 (range, 0.5-12.9) years post-LT. A total of 263 deceased donor grafts were used, and 73 were EDC grafts. A diagnosis of rPSC was made in 61 of the 263 grafts (23%). The recurrence-free patient survival was significantly better (P Ͻ 0.05) in patients who underwent pre-/peri-LT colectomy and in those with non-EDC grafts. In conclusion, in this larger cohort of 230 patients and with longer follow-up of 82.5 (range, 0.0-238.6) months [in comparison with the previous report of 152 recipients with a follow-up of 52.8 (range, 1-146) months], we have shown that colectomy remains a significant risk factor for rPSC and that colectomy before and during initial LT for PSC confers a protective effect against rPSC in subsequent graft(s). Moreover, we have shown that EDC grafts are also a significant risk factor for rPSC. Liver Transpl 15:330-340, 2009. © 2009 AASLD. Received July 9, 2008 accepted September 23, 2008.Five years ago, we published a retrospective multivariable analysis of the risk factors associated with recurrent primary sclerosing cholangitis (rPSC) in liver allografts after transplantation and reported that the presence of an intact colon before transplantation was significantly associated with recurrence.

A review of liver disorders in inflammatory bowel disease (IBD)

“…The outcome from liver transplantation for PSC is substantially better than would be predicted from natural history models [91,92]. The possibility of recurrent PSC in the transplanted liver exists, however, and may affect graft and patient survival [93][94][95].…”

Extraintestinal Manifestations of Ulcerative Colitis

“…Orthotopic liver transplantation is the established treatment in PSC with 85% to 90% of 5-year survival rate (Gow & Chapman, 2000). However, 20 to 25% of transplanted patients develop recurrent PSC 5 to 10 years after transplant (Alabraba et al, 2009;Campsen et al, 2008;Graziadei et al, 1999;Navaneethan & Shen, 2010).…”

Recurrencia de la enfermedad hepática primaria después del trasplante hepático

“…Estos hallazgos fueron más frecuentes en los pacientes que fueron trasplantados debido a CEP. Los factores que se han visto asociados con la recurrencia de CEP incluyen una incidencia más alta de HLA-DRB1*08, la edad del receptor, sexo masculino, la presencia de un colon intacto después del trasplante, rechazo agudo recurrente, rechazo agudo refractario a esteroides, y la presencia de un colangiocarcinoma previo al trasplante [9][10][11][12] . La eficacia del uso de ácido ursodeoxicólico o corticosteroides no ha sido demostrada en el manejo de la recurrencia de la CEP.…”