Systematic investigation of elevated cholestatic enzymes during the third posttransplant month

Mason, Andrew L.; Montano‐Loza, Aldo J.

doi:10.1002/lt.23742

Cited by 11 publications

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“…Biochemical mild cholestasis after LT was defined as ALP level >2Â ULN or a combined elevation of both bilirubin and ALP levels; whereas biochemical severe cholestasis was defined as (bilirubin !100 mmol [>5.9 mg/dL] or ALP >3Â ULN, as reported elsewhere. 18,22 Histologic Assessment for Recurrent Primary Biliary Cholangitis…”

Section: Liver Biochemistry Tests Post-liver Transplantationmentioning

confidence: 99%

“…4,10,[15][16][17] The relevance of other factors associated with recurrence of PBC, such as changes in the liver biochemistry shortly after LT, remain relatively unexplored in PBC, whereas biochemical evidence of early cholestasis has been associated with recurrent disease and worse outcomes in patients with chronic hepatitis C infection and primary sclerosing cholangitis. 18 Accordingly, we conducted a multicenter study in 13 LT centers to evaluate the probability and risk factors associated with recurrence of PBC and the association between recurrence of PBC and patient and graft survival. Second, to determine biomarkers that may identify patients at risk of PBC recurrence, we evaluated whether liver biochemistry tests within the first year after LT were associated with subsequent recurrent disease.…”

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confidence: 99%

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Factors Associated With Recurrence of Primary Biliary Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival

et al. 2019

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e17. Learning Objective: Upon completion of this CME activity, successful learners will be able to identify the factors associated with recurrence of primary biliary cholangitis after liver transplantation and define its effect on graft and patient survival. 785 pts received Liver Transplant (LT) due to Primary Biliary Cholangitis (PBC) Global PBC Group 240 pts developed Recurrence of PBC Gastroenterology 2019;156:96-107 CLINICAL LIVER transplantation were analyzed to determine whether markers of cholestasis could identify patients with recurrence of PBC (based on histologic analysis). Patients were followed for a median 6.9 years (interquartile range, 6.1-7.9 years). RESULTS: PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis <50 years (hazard ratio [HR], 1.79; 95% CI, 1.36-2.36; P < .001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02-1.90; P ¼ .04), use of tacrolimus (HR, 2.31; 95% CI, 1.72-3.10; P < .001), and biochemical markers of severe cholestasis (bilirubin !100 mmol or alkaline phosphatase >3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16-2.76; P ¼ .008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46-0.82; P ¼ .001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16-3.51; P ¼ .01) and death (HR, 1.72; 95% CI, 1.11-2.65; P ¼ .02). CONCLUSIONS: Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.

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Section: Liver Biochemistry Tests Post-liver Transplantationmentioning

confidence: 99%

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confidence: 99%

Factors Associated With Recurrence of Primary Biliary Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival

et al. 2019

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“…Taken together, these clinical observations have broadened our understanding of PSC in the setting of LT and stimulated discussion on factors in the colon that may trigger r PSC. We recently assessed early changes in cholestatic liver tests in PSC patients at 3 months following LT to address the hypothesis that early events, such as an infectious process in the allograft, may subsequently impact on the development of r PSC . Patients with cholestasis at 3 months had a higher probability of developing r PSC that became apparent within the ensuing years (Grade B, level 2b) (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…The probability of recurrent PSC was higher for patients with cholestasis at 3 months vs. patients with no cholestasis with median times to recurrence of 115 ± 14 and 155 ± 10 months respectively ( P = 0.02). Reprinted with permission from Mason et al ., Wiley Online Library.…”

Section: Methodsmentioning

confidence: 99%

“…It is generally accepted that dominant strictures with a stenosis ≤1.5 mm in the common bile duct or ≤1 mm in the hepatic ducts should be treated endoscopically if present . While endoscopic dilatation of dominant strictures or dilation and stent placement can provide long‐term biliary drainage and reduce symptoms, data from randomised, clinical‐controlled trails are lacking.…”

Section: Methodsmentioning

confidence: 99%

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Systematic review: recurrent autoimmune liver diseases after liver transplantation

Montano‐Loza

Bhanji

Wasilenko

et al. 2016

Aliment Pharmacol Ther

103

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Recommendations based on grade A level of evidence are lacking. The need for further study and management includes active immunosuppression before liver transplantation and steroid use after liver transplantation in autoimmune hepatitis; selective immunosuppression with ciclosporin and preventive ursodeoxycholic acid treatment for primary biliary cholangitis; and improved control of inflammatory bowel disease or even colectomy in primary sclerosing cholangitis.

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Post-Transplant Disease Recurrence in Pediatric PSC

Soufi

Bazerbachi

Deneau

2018

Curr Gastroenterol Rep

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Recurrent PSC is a significant complication that afflicts 16% of children after liver transplantation for primary sclerosing cholangitis (PSC) at a median onset of 38 months post-transplant. Possible risk factors include younger age at PSC diagnosis or transplant, the presence of overlap syndrome or IBD, and post-transplant induction with thymoglobulin. rPSC impairs the patient's quality of life and can be detrimental to the graft. Preventive options and therapeutic measures are limited. Ursodeoxycholic acid is widely used, but its effect on long-term outcome is unknown. Vancomycin can improve the biochemical profile of rPSC, but it remains unknown whether it halts the disease progression. Pediatric liver transplant for primary sclerosis cholangitis can be complicated by recurrence of the disease, which portends poor outcomes. Although few risk factors have been implicated, larger studies with longer follow-ups are needed to characterize cardinal risk factors for rPSC, as well as evaluate possible preventative and therapeutic options.

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Systematic investigation of elevated cholestatic enzymes during the third posttransplant month

Cited by 11 publications

References 13 publications

Factors Associated With Recurrence of Primary Biliary Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival

Factors Associated With Recurrence of Primary Biliary Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival

Systematic review: recurrent autoimmune liver diseases after liver transplantation

Post-Transplant Disease Recurrence in Pediatric PSC

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