Patients with primary sclerosing cholangitis with and without end-stage liver disease have similar outcomes after liver transplantation

Table 1 Cohort characteristics, n (%)

Characteristic	Total (n = 131)	ESLD (n = 72)	nESLD (n = 59)	P value
Sex
Male	96 (73.3)	49 (68.1)	47 (79.7)	-
Female	35 (26.7)	23 (31.9)	12 (20.3)	-
Age at LT, median (IQR)	38 (30, 47)	40 (33, 51)	37 (28, 45)	NS
MELD at LT, median (IQR)	15 (12, 19)	17 (13, 21)	13 (11, 15)	-
PSC phenotype
Large duct	130 (99.2)	72 (98.6)	59 (100.0)	NS
Small duct	1 (0.8)	1 (1.4)	0 (0.0)	-
PSC/AIH overlap	33 (25.2)	24 (33.3)	9 (15.3)	0.025
IBD
UC	86 (65.6)	42 (58.3)	44 (74.6)	-
CD	7 (5.3)	6 (8.3)	1 (1.7)	-
No IBD	38 (29.0)	24 (33.4)	14 (23.7)	NS
Colectomy
Before LT	6 (4.6)	3 (4.2)	3 (5.1)	NS
After LT	14 (10.7)	5 (6.9)	9 (15.3)	-
rPSC
Present	44 (33.6)	23 (31.9)	21 (35.6)	NS
No rPSC	87 (66.4)	49 (68.1)	38 (64.4)	-
Immunosuppression
Tacrolimus	113 (86.3)	63 (87.5)	50 (84.7)	NS
Cyclosporine	18 (13.7)	9 (12.5)	9 (15.3)	-
Donor type
DBD	131 (100.0)	72 (100.0)	59 (100.0)	NS
DCD	0 (0.0)	0 (0.0)	0 (0.0)	-
Anastomosis
Roux-en-Y	78 (59.5)	39 (54.2)	39 (66.1)	NS
Duct-to-duct	53 (40.5)	33 (45.8)	20 (33.9)	-
Follow-up, median (minimum, maximum)	7.85 (4.57, 12.98)	7.81 (5.11, 13.03)	8.20 (4.57, 12.59)	NS

AIH: Autoimmune hepatitis; CD: Crohn’s disease; DBD: Donation after brain death; DCD: Donation after brain death; ESLD: End-stage liver disease; IBD: Inflammatory bowel disease; IQR: Interquartile range; LT: Liver transplantation; MELD: Model for end-stage liver disease; nESLD: No end-stage liver disease; NS: Not significant; PSC: Primary sclerosing cholangitis; rPSC: Recurrence of primary sclerosing cholangitis; UC: Ulcerative colitis.

Table 2 Univariate and multivariate analyses of risk factors for recurrence of primary sclerosing cholangitis

Characteristic	Univariable				Multivariable
	n	HR	95%CI	P value	HR	95%CI	P value
Age at LT	131	0.99	0.96-1.01	0.4	0.99	0.96-1.02	0.5
Sex	131	-	-	-	-	-	-
Female	-	-	-	-	-	-	-
Male	-	1.17	0.59-2.31	0.7	1.23	0.54-2.78	0.6
Overlap PSC/AIH	131	1.54	0.80-2.95	0.2	2.13	0.87-5.21	0.1
IBD before LT	131	1	0.52-1.91	> 0.9	1.05	0.50-2.17	> 0.9
Liver cirrhosis	131	1.78	0.70-4.52	0.2	2.34	0.82-6.69	0.11
Decompensation of liver cirrhosis	131	0.96	0.53-1.74	0.9	0.84	0.32-2.17	0.7
Child-Pugh score prior to LT	131	1.09	0.94-1.26	0.3	-	-	-
MELD prior to LT	131	1.03	0.98-1.09	0.2	1	0.93-1.07	> 0.9
End-stage liver disease indication	131	0.92	0.51-1.66	0.8	1.04	0.39-2.73	> 0.9
Split or reduced liver graft	131	2.42	0.93-6.26	0.07	5	1.62-15.4	0.005
Donor type	131	-	-	-	-	-	-
DBD-ECD	-	-	-	-	-	-	-
DBD-SCD	-	0.62	0.31-1.25	0.2	1.06	0.45-2.49	0.9
Donor-recipient sex missmatch	131	1.37	0.76-2.49	0.3	1.65	0.78-3.52	0.2
Cyclosporine	131	0.52	0.20-1.33	0.2	0.4	0.13-1.27	0.12
Duct-to-duct anastomosis	131	1.32	0.70-2.47	0.4	0.91	0.41-2.03	0.8
Episode of ACR	131	1.19	0.66-2.15	0.6	1.08	0.52-2.26	0.8
Multiple episodes of ACR	131	2.28	1.06-4.91	0.036	3.95	1.44-10.8	0.008
CMV infection	131	2.1	1.14-3.89	0.018	2.16	1.05-4.46	0.037
Length of hospitalization	131	1.01	1.00-1.03	0.12	1.02	1.01-1.04	0.009

ACR: Acute cellular rejection; AIH: Autoimmune hepatitis; CI: Confidence interval; CMV: Cytomegalovirus; DBD: Donation after brain death; ECD: Expanded criteria donor; HR: Hazard ratio; IBD: Inflammatory bowel disease; LT: Liver transplantation; MELD: Model for end-stage liver disease; PSC: Primary sclerosing cholangitis; SCD: Standard criteria donor.

Table 3 Univariate and multivariate analyses of graft failure risk factors

Characteristic	Univariable				Multivariable
	n	HR	95%CI	P value	HR	95%CI	P value
Age at LT	131	0.98	0.94-1.01	0.2	0.97	0.92-1.02	0.2
Sex	131	-	-	-	-	-	-
Female	-	-	-	-	-	-	-
Male	-	1.69	0.56-5.09	0.3	2.67	0.61-11.7	0.2
Overlap PSC/AIH	131	1.53	0.55-4.29	0.4	4.07	0.93-17.9	0.063
IBD before LT	131	0.77	0.31-1.93	0.6	1.28	0.39-4.15	0.7
Liver cirrhosis	131	1.33	0.39-4.55	0.7	1.34	0.29-6.18	0.7
Decompensation of liver cirrhosis	131	1.02	0.42-2.48	> 0.9	0.69	0.17-2.77	0.6
Child-Pugh score prior to LT	131	1.06	0.83-1.36	0.6	-	-	-
MELD prior to LT	131	1.01	0.93-1.10	0.8	0.95	0.82-1.10	0.5
End-stage liver disease indication	131	0.93	0.39-2.25	0.9	1.73	0.36-8.38	0.5
Split or reduced graft	131	1.55	0.20-12.2	0.7	4.76	0.46-48.8	0.2
Donor type	131	-	-	-	-	-	-
DBD-ECD	-	-	-	-	-	-	-
DBD-SCD	-	0.81	0.22-2.90	0.7	2.29	0.45-11.5	0.3
Donor-recipient sex missmatch	131	1.22	0.50-2.96	0.7	2.21	0.63-7.80	0.2
Cyclosporine	131	0.54	0.17-1.76	0.3	0.21	0.04-1.06	0.059
Duct-to-duct anastomosis	131	0.76	0.25-2.36	0.6	0.58	0.14-2.46	0.5
Episode of ACR	131	1.51	0.62-3.72	0.4	1.36	0.38-4.81	0.6
Multiple episodes of ACR	131	3.48	1.32-9.14	0.011	4.93	1.22-19.9	0.025
CMV infection	131	2.14	0.87-5.24	0.10	2.51	0.77-8.19	0.13
Length of hospitalization	131	1.02	1.00-1.04	0.029	1.04	1.01-1.06	0.001

ACR: Acute cellular rejection; AIH: Autoimmune hepatitis; CI: Confidence interval; CMV: Cytomegalovirus; DBD: Donation after brain death; ECD: Expanded criteria donor; HR: Hazard ratio; IBD: Inflammatory bowel disease; LT: Liver transplantation; MELD: Model for end-stage liver disease; PSC: Primary sclerosing cholangitis; SCD: Standard criteria donor.