Recurrence of primary sclerosing cholangitis after liver transplantation — The Hungarian experience

Gelley, Fanni; Zádori, Gergely; Görög, Dénes; Kopper, László; Fehérvári, Imre; Gámán, György; Gerlei, Zsuzsanna; Nagy, Péter; Sárváry, Enikő; Nemes, Balázs

doi:10.1556/imas.6.2014.1.2

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…IBD presence (ulcerative colitis and Crohn's disease) was evaluated in eight studies, of which two studies did not provide enough information to calculate the HR. Among the six remaining studies, Hildebrand et al found IBD presence to be a significant risk factor for rPSC with HR of 1.15 (95% CI: 1.15‐4.75) .…”

Section: Resultsmentioning

confidence: 66%

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Systematic review with meta‐analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation

Steenstraten

Korkmaz

Trivedi

et al. 2019

Aliment Pharmacol Ther

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Summary Background After liver transplantation primary sclerosing cholangitis (PSC), the condition returns in the transplanted liver in a subset of patients (recurrent primary sclerosing cholangitis, rPSC). Aim To define risk factors for rPSC. Methods We searched Pubmed, Embase, Web of Science, and Cochrane library for articles published until March 2018. Studies addressing risk factors for developing rPSC were eligible for inclusion. A random effects meta‐analysis was conducted using hazard ratios (HR) as effect measure. Study quality was evaluated with the Newcastle Ottawa scale. Statistical analysis was performed using Cochrane Review Manager. Results The electronic database search yielded 449 results. Twenty‐one retrospective cohort studies met the inclusion criteria for the review; 14 were included in the meta‐analysis. The final cohort included 2159 patients (age range 31‐49 years, 68.8% male), of whom 17.7% developed rPSC. Colectomy before liver transplantation, HR 0.65 (95% CI: 0.42‐0.99), cholangiocarcinoma before liver transplantation, HR 2.42 (95% CI: 1.20‐4.86), inflammatory bowel disease, HR 1.73 (95% CI: 1.17‐2.54), donor age, HR 1.24 (95% CI 1.0‐1.45) per ten years, MELD score, HR 1.05 (95% CI: 1.02‐1.08) per point and acute cellular rejection, HR of 1.94 (95% CI: 1.32‐2.83) were associated with the risk of rPSC. Conclusions Multiple risk factors for rPSC were identified. Colectomy before liver transplantation reduced the risk of rPSC.

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Section: Resultsmentioning

confidence: 66%

“…Eight studies described colectomy before liver transplantation . Among these studies, two could not be evaluated due to overlapping cohorts .…”

Section: Resultsmentioning

confidence: 99%

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Systematic review with meta‐analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation

Steenstraten

Korkmaz

Trivedi

et al. 2019

Aliment Pharmacol Ther

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“…Previous evidence for a relationship between PSC recurrence and age has been conflicting, with some observing younger age to be a risk factor and others finding no age association [23–26]. Our analysis is somewhat different from these in that we could only assess cases of recurrence that led to graft failure, as opposed to all instances of recurrent disease.…”

Section: Discussionmentioning

confidence: 99%

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

et al. 2017

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Background There is increasing evidence for a heterogeneity of phenotypes in primary sclerosing cholangitis (PSC), but differences across the age spectrum in adults with PSC have not been well characterized. Aims To characterize phenotypic variations and liver transplantation outcomes by age group in adults with PSC. Methods The United Network for Organ Sharing database was used to identify waitlist registrations for primary liver transplantation in adults with PSC. Patients were split into three age groups: 18–39 (young), 40–59 (middle-aged), and ≥60 (older). Their clinical characteristics and outcomes on the waitlist and post-transplant were compared. Results Overall, 8272 adults with PSC were listed for liver transplantation during the study period, of which 28.9% were young, 52.0% were middle-aged, and 19.1% were older. The young age group had the greatest male predominance (70.0 vs. 66.2 vs. 65.1%, p = 0.001), the highest proportion of black individuals (20.0 vs. 11.0 vs. 5.5%, p <0.001), and the most patients listed with concomitant autoimmune hepatitis (2.2 vs. 1.0 vs. 0.8%, p <0.001). Older patients experienced the greatest waitlist and post-transplant mortality. Graft survival was greatest in the middle-aged group. Young patients were most likely to experience acute rejection (31 vs. 22.8 vs. 18.0%, p <0.001) and have graft failure due to chronic rejection or PSC recurrence (47.8 vs. 42.3 vs. 17.9%, p < 0.001). Conclusions Age-related differences exist among adults with PSC and are associated with outcomes pre- and post-transplant. Young patients may have a more robust immune-related phenotype that is associated with poorer graft survival. Future studies are needed to further investigate these findings.

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“…However, the outcome of liver transplantation for PSC patients is affected by recurrent disease in 20% of population (19,20). There is a negative impact of recurrent PSC (rPSC) on Graft function and patients survival with increased risk of graft dysfunction and death among patients with rPSC (19,21). Several risk factors for rPSC have been identified, but the impact of IgG4 on rPSC after liver transplant is still unknown (19,(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

IgG4 Status in Explanted Livers Does Not Affect the Outcome of Primary Sclerosing Cholangitis (PSC) After Liver Transplant

et al. 2018

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Background: The outcome of primary sclerosing cholangitis (PSC) after liver transplantation can be affected by recurrent PSC (rPSC) and subsequent graft failure. IgG4-related sclerosing disease is a recently described entity that has a similar morphological appearance to PSC, making the distinction difficult. However, IgG4-related sclerosing cholangitis has an excellent prognosis since it is steroid sensitive, but the impact of IgG4 on rPSC after liver transplant is still unknown. Objectives: To determine the association between IgG4 positive immunochemical staining in liver explants and recurrence of primary sclerosing cholangitis post-liver transplantation. Methods: Clinical information on all adult patients who underwent liver transplantation for PSC from 1990 to 2014 at our institution was obtained. IgG4 immunochemical staining was performed on the porta-hepatis region of these patient's explanted livers. Immunochemical staining was considered to be positive if the score was > 5 cells/high power field (HPF). Results: Eighty patients met inclusion criteria. IgG4 staining was positive in 21 subjects. Median time for follow-up in the IgG4 positive group was 99.6 months compared to 152.6 months in the IgG4 negative. There were more instances of rPSC in the IgG4 negative group compared to the IgG4 positive group (26% vs. 5%, P < 0.009), and rPSC occurred earlier in the IgG4 negative group (P = 0.016). The frequency of graft failure, however was not significantly different among the two groups. Conclusions: The presence of IgG4 positive cells in liver explants of patient's transplanted for PSC is associated with fewer episodes of and longer time to recurrent PSC. In addition, IgG4 status of the liver explants does not affect graft survival. Presence of IgG4 positive cells may suggest protective effect against recurrence of PSC.

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Recurrence of primary sclerosing cholangitis after liver transplantation — The Hungarian experience

Abstract: Recurrent PSC significantly affects long-term mortality and graft loss. Younger age at OLT, higher donor BMI and severe active IBD may be associated with PSC recurrence. PreOLT total colectomy might have protective effect against rPSC.

Cited by 12 publications

References 10 publications

Systematic review with meta‐analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation

Systematic review with meta‐analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

IgG4 Status in Explanted Livers Does Not Affect the Outcome of Primary Sclerosing Cholangitis (PSC) After Liver Transplant

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