Risk factors and prognosis for recurrent primary sclerosing cholangitis after liver transplantation: a Nordic Multicentre Study

Abstract

This study confirms that colectomy before liver transplantation is associated with a decreased risk of rPSC. Inflammatory activity of IBD was not associated with the risk of rPSC. Tacrolimus was an independent risk factor for PSC recurrence and its use as first line immunosuppression in PSC needs further study.

The impact of ileal pouch‐anal anastomosis on graft survival following liver transplantation for primary sclerosing cholangitis

“…Our institution and others have previously reported a lower incidence of recurrent biliary stricturing disease post‐transplant for patients undergoing colectomy . In the present cohort, we found that this potentially protective effect was confined to patients retaining an end ileostomy (Figure A), whereas the incidence of recurrent biliary strictures was not significantly different between IPAA and no colectomy groups (Figure B).…”

“…Herein, we identify that any protective effect conferred following colectomy (with regard to recurrent biliary disease) is skewed towards the patient group retaining an end ileostomy, whereas no benefit is evident for patients with an IPAA. As patients with PSC and IPAA often develop pouchitis and poorer pouch function, it is plausible that persistent or recurrent episodes of intestinal inflammation also contribute to an elevated risk of thrombotic injury, akin to that when the colon is retained . Although speculative, evidence to support this hypothesis includes the fact that our ileostomy group experienced the lowest incidence of hepatic artery thrombosis; in addition to findings that show persistent subclinical intestinal inflammation in PSC associated colitis, associations between pouchitis and thrombocytosis, and heightened platelet activation during active IBD…”

“…Following liver transplantation, colectomy does not appear protective against graft loss per se, although data from several centres indicate that retention of an intact colon, particularly one associated with ongoing inflammatory activity post‐transplant, increases the risk of developing post‐transplant complications including disease recurrence and hepatic artery thrombosis …”

Key roles of hepatologists in successful liver transplantation

“…Recurrent PSC after LT was reported in Pittsburgh in 1988 . Recurrence occurs in 17–27% of cases with a duration of 8 months to 6 years . The diagnosis of PSC recurrence in a graft liver is often difficult.…”

“…74 Recurrence occurs in 17-27% of cases with a duration of 8 months to 6 years. [75][76][77][78][79][80] The diagnosis of PSC recurrence in a graft liver is often difficult. An increase in hepatobiliary enzymes and narrowing of the bile duct on a magnetic resonance cholangiography image, stenosis, and dilation are the basis for the clinical diagnosis, but an occluded hepatic artery also shows the same demographics.…”