Recurrence of primary sclerosing cholangitis after liver transplantation – analysing the European Liver Transplant Registry and beyond
Thijmen Visseren, Nicole S. Erler, Wojciech G. Polak, René Adam, Vincent Karam, Florian W. R. Vondran, Bo‐Göran Ericzon, Douglas Thorburn, Jan N.M. IJzermans, Andreas Paul, Frans van der Heide, Pavel Taimr, Petr Němec, Jacques Pirenne, Renato Romagnoli, Herold J. Metselaar, Sarwa Darwish Murad, Florian W. R. Vondran, Annika Bergquist, Lina Lindström, Victoria Snowdon, Andreas Paul, Frans van der Heide, Pavel Trunečka, Jacques Pirenne, Mauro Salizzoni, Andreas Arendtsen Rostved, G. Arenga, Gabriela Berlakovich, Daniel Candinas, Saša Marković, Roberto Troisi, Bart van Hoek, Turan Kanmaz, Murat Dayangaç, Thierry Berney, D. Sforza, Bruno Gridelli, Pierre–Alain Clavien, Maria Hoppe‐Lotichius, N. Senninger, Thomas Lorf, Utz Settmacher, Valentín Cuervas‐Mons, Aylin Bacakoğlu, Silvio Nadalin, Valentina Serra, Marek Pacholczyk, Umberto Baccarani, Cristina Dopazo Taboada, Marina Berenguer, Fernando San Juan, Olivier Detry, Dirk L. Stippel, Philippe Evrard, Jean Gugenheim, Murat Kılıç, Carlos Fernández Selles, Luis Antonio Herrera Norena, Fabio Melandro, I González-Pinto, Daniele Nicolini, Fernando Pardo Sánchez, Christoph Neumann‐Haefelin
Abstract
Liver transplantation for primary sclerosing cholangitis (PSC) can be complicated by recurrence of PSC (rPSC). This may compromise graft survival but the effect on patient survival is less clear. We investigated the effect of post-transplant rPSC on graft and patient survival in a large European cohort. Registry data from the European Liver Transplant Registry regarding all first transplants for PSC between 1980 and 2015 were supplemented with detailed data on rPSC from 48 out of 138 contributing transplant centres, involving 1,549 patients. Bayesian proportional hazards models were used to investigate the impact of rPSC and other covariates on patient and graft survival. Recurrence of PSC was diagnosed in 259 patients (16.7%) after a median follow-up of 5.0 years (quantile 2.5%-97.5%: 0.4-18.5), with a significant negative impact on both graft (HR 6.7; 95% CI 4.9-9.1) and patient survival (HR 2.3; 95% CI 1.5-3.3). Patients with rPSC underwent significantly more re-transplants than those without rPSC (OR 3.6, 95% CI 2.7-4.8). PSC recurrence has a negative impact on both graft and patient survival, independent of transplant-related covariates. Recurrence of PSC leads to higher number of re-transplantations and a 33% decrease in 10-year graft survival.