Risk factors for recurrence of primary sclerosing cholangitis after liver transplantation

Abstract

Orthotopic liver transplantation (OLT) is the only effective treatment for end-stage liver disease due to primary sclerosing cholangitis (PSC)., and steroid-resistant ACR (29% versus 0%; P ‫؍‬ 0.012). Despite the strong linkage disequilibrium between DRB1*08 and DQB1*04, DRB1*08-positive subjects with recurrence were negative for DQB1*04, whereas the single DRB1*08-positive subject without recurrent PSC was positive for DQB1*04. A history of ACR and presence of HLA-DRB1*08 are associated with increased risk of recurrent PSC, suggesting an immunologic mechanism for this syndrome. Further studies are required to confirm these observations and to understand the underlying mechanisms.

Survival Without Biliary Complications After Liver Transplant for Primary Sclerosing Cholangitis

“…Only 1 human leukocyte antigen haplotype (DR3) may be related to recurrent primary sclerosing cholangitis after orthotopic liver transplant, and DR3, DQ2 or DR6 may not be linked to recurrent primary sclerosing cholangitis. 22 The DR8 haplotype was not present in our cohort.…”

“…21 Recurrent primary sclerosing cholangitis after orthotopic liver transplant is associated with HLA-DRB1*08 (DR8) but not with DR3-and DQ2-heterozygosity or DR6. 22 In contrast with the first occurrence of primary sclerosing cholangitis, 23 there is controversy about the effect of human leukocyte antigen disparity between donor and recipient on recurrence of primary sclerosing cholangitis. The risk of recurrent primary sclerosing cholangitis is increased by mismatch at the A locus and decreased by mismatch at the DR locus.…”

Reply: The urgent need for evaluating recurrent primary sclerosing cholangitis in living donor liver transplantation

“…7 For these reasons, we are very cautious about drawing any conclusions from the apparent greater risk of recurrence of PSC in living donor transplant recipients. Others have reported the impact of genetic factors [8][9][10] on the recurrence of PSC after deceased donor liver transplantation, and this may account for multiple recurrences in some patients of our series. 7 We would welcome larger and collaborative studies with common protocols to define more clearly the rates of recurrence, impact on graft survival, and risk factors.…”

Primary Sclerosing Cholangitis and Ulcerative Colitis

“…In the current literature, there is limited information on what clinical variables may influence recurrence. A retrospective analysis was performed, which focused on the risk factors leading to allograft failure in PSC patients (Alexander 2008). The three most important factors that lead to failure included; acute cellular rejection, steroid-resistant acute cellular rejection and HLA-DRB1 association.…”