A re-evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts
Open accessAbstract
Previously, we have found that the absence of the colon after liver transplantation (LT) protects the patient from recurrent primary sclerosing cholangitis (rPSC). As our previous observation has not been confirmed in other series, we have reviewed our cohort of patients grafted for primary sclerosing cholangitis (PSC) with greater numbers and longer follow-up to reassess the rate, consequences, and risk factors for rPSC. We collected data on patients who underwent LT for PSC between January 1986 and April 2006. Data were collected for cytomegalovirus status, inflammatory bowel disease status, time of colectomy, type of colectomy, donor-recipient gender mismatch, recipient sex, extended donor criteria (EDC), and donor risk index. Accepted criteria were used to diagnose rPSC. Of a total of 230 consecutive adult patients, 61 (27%) underwent colectomy pre-/peri-LT, and 54 (23.5%) developed rPSC at a median of 4.6 (range, 0.5–12.9) years post-LT. A total of 263 deceased donor grafts were used, and 73 were EDC grafts. A diagnosis of rPSC was made in 61 of the 263 grafts (23%). The recurrence-free patient survival was significantly better (P < 0.05) in patients who underwent pre-/peri-LT colectomy and in those with non-EDC grafts. In conclusion, in this larger cohort of 230 patients and with longer follow-up of 82.5 (range, 0.0–238.6) months [in comparison with the previous report of 152 recipients with a follow-up of 52.8 (range, 1–146) months], we have shown that colectomy remains a significant risk factor for rPSC and that colectomy before and during initial LT for PSC confers a protective effect against rPSC in subsequent graft(s). Moreover, we have shown that EDC grafts are also a significant risk factor for rPSC.
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Colectomy appears to protect against rPSC.
“There has been considerable debate associated with findings that colectomy appears to protect against rPSC.412,413”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [412]
There is currently no available treatment for PSC patients and liver transplantation is the only curative option.
“In this line, there is currently no available treatment for PSC patients and liver transplantation is the only curative option, which has obvious shortcomings including scarcity of donors and a high incidence of recurrence19.”
From Cholestasis induced by bile duct ligation promotes changes in the intestinal microbiome in mice (2019) · cites this paper as [19]
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Self-citation
- Authors
- Alabraba, E., Nightingale, P., Gunson, B., Hubscher, S., Olliff, S., Mirza, D., & Neuberger, J.
- Affiliations
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Corresponding author
- Neuberger, James
- Venue
- Liver Transplantation
- Published
- 2009-03
- Volume
- 15
- Issue
- 3
- Pages
- 330-340
- ISSN
- 1527-6465 (ISSN-L)
- OpenAlex
- W2066392072
- Cited by
- 298
- References
- 44
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 18 · 2023: 20 · 2022: 7 · 2021: 13 · 2020: 18 · 2019: 17 · 2018: 25 · 2017: 30 · 2016: 17 · 2015: 18 · 2014: 20 · 2013: 22 · 2012: 12
- FWCI
- 10.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Liver Transplantation (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Keywords
- primary sclerosing cholangitis, recurrence, colectomy, risk factors, extended criteria donors, donor risk index, donor-recipient sex mismatch, cytomegalovirus, inflammatory bowel disease, graft survival
- MeSH terms
- Adolescent, Adult, Aged, Cadaver, Colectomy, Female, Follow-Up Studies, Graft Rejection, Graft Survival, HLA Antigens, Humans, Immunosuppressive Agents, Male, Middle Aged, Recurrence, Retrospective Studies, Risk Factors, Sex Characteristics, Tissue Donors, Transplantation, Homologous, Cholangitis, Sclerosing, Survival Analysis, Liver Transplantation, Survivors, Patient Selection, Young Adult
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