Risk of recurrence of primary sclerosing cholangitis after liver transplantation is associated with <i>de novo</i> inflammatory bowel disease

Bajer, Lukáš; Slavčev, Antonij; Mačinga, Peter; Sticová, Eva; Březina, Jan; Roder, Matej; Janoušek, R; Trunečka, Pavel; Špičák, Julius; Drastich, Pavel

doi:10.3748/wjg.v24.i43.4939

Cited by 12 publications

(5 citation statements)

References 41 publications

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“…Although many studies have examined the risk factors, it is unclear why rPSC develops post-LT. One of the main risk factors is IBD, as demonstrated with the decreased frequency of rPSC following colectomy prior to LT [128] . Others have reported that the presence of ulcerative colitis post-LT is significantly associated with the development of rPSC [129] . In those without a prior history of ulcerative colitis, the development of de novo colitis increases the risk considerably [130] .…”

Section: Pathogenesis and Risk Factors For Recurrent Pscmentioning

confidence: 98%

“…Immunosuppression: Cyclosporine use decreased risk as compared to tacrolimus [110][111][112]107,110] Genetic predisposition [108] Increased donor age, warm and cold ischemic time [109,112,114] Preventative use of UDCA, and in combination with cyclosporine, post LT reduced the risk of rPBC [115] rPSC 20% to 25% [2] Diagnosis of PSC prior to LT and cholangiography showing non-anastomotic intrahepatic and/or extrahepatic bile duct strictures with irregularities and beading occurring more than 90 days post-LT Or Liver biopsy demonstrating fibrous cholangitis and/or fibro-obliterative lesions [127] Inflammatory bowel disease [128][129][130] Acute cellular rejection [131,132,134,135] Donor-recipient CMV mismatch [133] Poor graft quality [133] Pre-transplant MELD > 24 [133,135] Cholangiocarcinoma [134,135] Higher donor age [134] No proven therapies Symptomatic management ALT: Alanine aminotransferase; AST: aspartate transaminase; CMV: cytomegalovirus; MELD: model for end stage liver disease; MMF: mycophenolate mofetil; UDCA: ursodeoxycholic acid.…”

Section: Incidence and Diagnosis Of Aih Recurrencementioning

confidence: 99%

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Autoimmune liver diseases, hepatocellular carcinoma, and recurrence of autoimmunity post-liver transplantation

Wang¹,

Dong²,

Montaño-Loza³

et al. 2021

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Liver transplantation for the autoimmune liver diseases (AILD), which includes autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), is indicated in the setting of decompensated cirrhosis, liver failure, and hepatocellular carcinoma (HCC). The risk of HCC is thought to be low in AILD, though data on the risk factors and predictors of HCC are limited in this population. Recurrence of AILD can occur in over half of the patients, complicating the post-transplant course. The pathogenesis of recurrent AILD involves a complex interaction of genetic and environmental influences, as well as a variety of clinical risk factors. Graft and patient survival are negatively impacted by recurrent AILD and the optimal approach to the treatment of AILD recurrence is the subject of ongoing research. This review will address the current literature on the risk of HCC in AILD, as well as the development and management of recurrent AILD post-liver transplantation.

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Section: Pathogenesis and Risk Factors For Recurrent Pscmentioning

confidence: 98%

Section: Incidence and Diagnosis Of Aih Recurrencementioning

confidence: 99%

Autoimmune liver diseases, hepatocellular carcinoma, and recurrence of autoimmunity post-liver transplantation

Wang¹,

Dong²,

Montaño-Loza³

et al. 2021

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“…IBD in general and UC in particular are associated with concomitant PSC, for which the mainstay of treatment is OLT. This is probably the reason for encountering higher number of OLT than SOT of other organs in the IBD population[ 159 , 160 ]. The incidence risk of developing de novo IBD in SOT recipients versus general population is 206 and 20 respectively per 100000 person-years[ 161 ].…”

Section: Post-transplant Secondary Ibdmentioning

confidence: 99%

“…In a retrospective chart review of 6800 liver and/or kidney transplant recipients that received some form of immunosuppression, it was found that 14 individuals developed de novo IBD[ 161 ]. Post-OLT patients who develop de novo IBD had a tendency to have underlying PSC or develop PSC in the future[ 160 , 163 ].…”

Section: Post-transplant Secondary Ibdmentioning

confidence: 99%

Secondary causes of inflammatory bowel diseases

Ghouri¹,

Tahan²,

Shen³

2020

WJG

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Inflammatory bowel diseases (IBD), conventionally consist of Crohn’s disease (CD) and ulcerative colitis. They occur in individuals with high risk genotype for the disease in the setting of appropriate environmental factors. The pathogenesis of IBD involves a dysregulated autoimmune response to gut dysbiosis, which in turn is triggered due to exposure to various inciting environmental factors. But there is no clearly defined etiology of IBD and this type of disease is termed as “idiopathic IBD”, “classic IBD”, or “primary IBD”. We reviewed the current medical literature and found that certain etiological factors may be responsible for the development of IBD or IBD-like conditions, and we consider this form of de novo IBD as “secondary IBD”. Currently known factors that are potentially responsible for giving rise to secondary IBD are medications; bowel altering surgeries and transplantation of organs, stem cells or fecal microbiome. Medications associated with the development of secondary IBD include; immunomodulators, anti-tumor necrosis factor alpha agents, anti-interleukin agents, interferons, immune stimulating agents and checkpoint inhibitors. Colectomy can in some cases give rise to de novo CD, pouchitis of the ileal pouch, or postcolectomy enteritis syndrome. After solid organ transplantation or hematopoietic stem cell transplantation, the recipient may develop de novo IBD or IBD flare. Fecal microbiota transplantation has been widely used to treat patients suffering from recurrent Clostridium difficile infection but can also causes IBD flares.

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“…Regarding rPSC, in one study which had all HLA data available for all donors and recipients, HLA-DRB1*08 allele was detected in either donor or recipient with rPSC [ 32 ]. On the other hand, in the study by Bajer et al, HLA-DRB1*07 in the donor represented a potential risk factor for rPSC [ 33 ]. For rNASH, G-allele in position rs738409 of patatin-like phospholipase domain-containing protein 3 (PNPLA3) presence in the recipient was associated with an increased hepatic concentration of triglycerides and with rMASH, though liver biopsy to confirm the diagnosis was only available in a minority of patients and recurrent disease diagnosis was based on biological and clinical criteria [ 34 ].…”

Section: Resultsmentioning

confidence: 99%

European Society for Organ Transplantation Consensus Statement on Biomarkers in Liver Transplantation

Berenguer,

de Martin,

Hessheimer

et al. 2023

Transpl Int

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Currently, one-year survival following liver transplantation (LT) exceeds 90% in large international registries, and LT is considered definitive treatment for patients with end-stage liver disease and liver cancer. Recurrence of disease, including hepatocellular carcinoma (HCC), significantly hampers post-LT outcomes. An optimal approach to immunosuppression (IS), including safe weaning, may benefit patients by mitigating the effect on recurrent diseases, as well as reducing adverse events associated with over-/under-IS, including chronic kidney disease (CKD). Prediction of these outcome measures—disease recurrence, CKD, and immune status—has long been based on relatively inaccurate clinical models. To address the utility of new biomarkers in predicting these outcomes in the post-LT setting, the European Society of Organ Transplantation (ESOT) and International Liver Transplant Society (ILTS) convened a working group of experts to review literature pertaining to primary disease recurrence, development of CKD, and safe weaning of IS. Summaries of evidence were presented to the group of panelists and juries to develop guidelines, which were discussed and voted in-person at the Consensus Conference in Prague November 2022. The consensus findings and recommendations of the Liver Working Group on new biomarkers in LT, clinical applicability, and future needs are presented in this article.

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Risk of recurrence of primary sclerosing cholangitis after liver transplantation is associated with de novo inflammatory bowel disease

Cited by 12 publications

References 41 publications

Autoimmune liver diseases, hepatocellular carcinoma, and recurrence of autoimmunity post-liver transplantation

Autoimmune liver diseases, hepatocellular carcinoma, and recurrence of autoimmunity post-liver transplantation

Secondary causes of inflammatory bowel diseases

European Society for Organ Transplantation Consensus Statement on Biomarkers in Liver Transplantation

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