Michael Schoech, MD
Cincinnati, Ohio
Michael Schoech, MD, Kenneth Sherman, MD, PhD
University of Cincinnati College of Medicine, Cincinnati, OH
Introduction: Recurrent primary sclerosing cholangitis after liver transplantation occurs in approximately 10-25% of patients. rPSC is the leading cause of graft loss and mortality and significantly increases the need for retransplantation. Prior studies have suggested that Inflammatory bowel disease (IBD) with an intact colon is risk factor for the development of rPSC. Our aim was to evaluate whether IBD with or without a colectomy significantly affected the development of rPSC, identify other risk factors for recurrence, and define the overall recurrence rate.
Methods: In this ongoing single center, retrospective cohort, 1086 transplants were performed at University of Cincinnati between 2003 to 2019. rPSC was defined using the Mayo Clinic criteria. A total of sixteen risk factors were considered including: age, gender, type of anastomosis, type of transplant, hepatic artery thrombosis, acute cellular rejection, IBD, type of IBD, colectomy, timing of colectomy, cholangiocarcinoma, MELD score, cold ischemic time, hepatitis B core antibody donor status, and smoking. Data were analyzed using Statistix 10.0 with an alpha= 0.05.
Results: 53/1086 liver transplants (4.9%) were performed in 48 patients for primary sclerosing cholangitis (PSC). Within the PSC group, the median age at transplant was 49 years with 72.5% male. The median MELD at transplant was 22, median cold ischemic time of 363 minutes, and a median follow-up of 47.5 months. 35 patients (68.6%) had IBD including 20 (57.1%) with ulcerative colitis. 9 patients (18.4%) developed rPSC in a median of 65 months. Among these, 67% developed subsequent graft loss from rPSC and 33% underwent retransplant (p< 0.03). As anticipated, HAT was a negative predictor for development of rPSC. There were no statistically significant risk factors for the development of rPSC, but rPSC patients were slightly younger (p< 0.06). In rPSC, graft loss (p< 0.004) and time to death (p< 0.007) occurred significantly later (107 and 102 months respectively) than in patients without rPSC.
Discussion: The overall recurrence rate of PSC (18.4%) is similar to prior studies without any discernable risk factors in this cohort. IBD and colectomy did not significantly reduce the rate of rPSC. rPSC leads to delayed graft loss and mortality with a high rate of retransplantation indicating an insidious disease process. Longer follow-up may increase the rate of rPSC, graft loss and mortality as a subset of individuals in the cohort were transplanted prior to the median recurrence time.
Citation: Michael Schoech, MD, Kenneth Sherman, MD, PhD. P1517 - RISK FACTORS FOR RECURRENT PRIMARY SCLEROSING CHOLANGITIS (RPSC) AFTER ORTHOTOPIC LIVER TRANSPLANT. Program No. P1517. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.