Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4939
Peer-review started: September 2, 2018
First decision: October 8, 2018
Revised: October 20, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: November 21, 2018
Processing time: 82 Days and 7.9 Hours
To evaluate risk factors for primary sclerosing cholangitis (PSC) recurrence (rPSC) after orthotopic liver transplantation (OLT) in patients with well-preserved colons.
We retrospectively evaluated the medical records of all patients transplanted for PSC in our center between July 1994 and May 2015 and selected 47 with follow-up of at least 60 mo for further analysis based on strict inclusion and exclusion criteria. rPSC was confirmed by magnetic resonance or endoscopic retrograde cholangiopancreatography and liver biopsy. All patients were evaluated by protocolary pre-OLT colonoscopy with randomized mucosal biopsies. Colonoscopy was repeated annually after OLT. Both organ donors and recipients were human leukocyte antigen (HLA) typed by serological and/or DNA methods. All input data were thoroughly analyzed employing relevant statistical methods.
Altogether, 31 men and 16 women with a median (range) age of 36 (15-68) years at the time of OLT and a median follow-up of 122 (60-249) mo were included. rPSC was confirmed in 21/47 (44.7%) of patients, a median 63 (12-180) mo after transplantation. De novo colitis [rPSC in 11/12, P ≤ 0.05, hazard ratio (HR): 4.02, 95% confidence interval (CI): 1.58-10.98] and history of acute cellular rejection (rPSC in 14/25, P ≤ 0.05; HR: 2.66, 95%CI: 1.03-7.86) showed strong positive associations with rPSC. According to the univariate analysis, overlapping features of autoimmune hepatitis (rPSC in 5/5, P ≤ 0.05) and HLA-DRB1*07 in the donor (rPSC in 10/15, P ≤ 0.05) represent other potential risk factors for rPSC, while the HLA-DRB1*04 (rPSC in 0/6, P ≤ 0.05), HLA-DQB1*03 (rPSC in 1/11, P ≤ 0.05), and HLA-DQB1*07 (rPSC in 0/7, P ≤ 0.05) recipient alleles may have protective roles.
De novo colitis and acute cellular rejection are clinical conditions significantly predisposed towards recurrence of PSC after liver transplantation.
Core tip: This study demonstrates that patients with de novo colitis after liver transplantation for primary sclerosing cholangitis (PSC) are significantly predisposed towards primary liver disease recurrence (rPSC). History of acute cellular rejection of the liver graft, overlapping features of autoimmune hepatitis (autoimmune hepatitis /PSC) and certain human leukocyte antigen (HLA)-DQ and HLA-DR alleles in both donors and recipients may also have an impact on rPSC development. These data based on analysis of well-defined cohort with long median follow-up suggest that thorough routine endoscopic, radiological and immunological examination (both pre- and post-transplant) is crucial for identifying high-risk patients.