High IgG4 levels among primary sclerosing cholangitis patients indicated shorter time to LT

CHICAGO — Patients with primary sclerosing cholangitis and high immunoglobulin G4 levels were more likely to require liver transplantation than those with normal levels and had a shorter time to transplantation, according to new data presented at Digestive Disease Week 2014.

Researchers conducted a retrospective chart review of 46 patients (mean age at diagnosis, 40 years; 72% men) with primary sclerosing cholangitis (PSC) enrolled at the University of Alberta Hospital, Edmonton, between 1987 and 2013. Sixty-seven percent of patients had inflammatory bowel disease, and all patients had immunoglobulin G4 (IgG4) at normal (<135 mg/dL) or high levels (>135 mg/dL) during the review (63 ± 8 months).

Ten patients had high levels of IgG4 (212 ± 13 mg/dL), and 36 had normal levels (42 ± 5 mg/dL), based on a mean of two IgG4 measurements. Those with high levels were younger compared with patients with lower levels (27 ± 5 years vs. 43 ± 3 years; P=.005), and they also displayed higher alkaline phosphatase (642 ±112 U/L vs. 311 ± 37 U/L; P=.02).

The median liver transplant-free survival rate was (124 ± 29 months vs. 181 ± 12 months; P=.01), concluding that those with greater IgG4 levels also had a shorter time to liver transplantation (LT) compared with patients with normal levels.

In area under the curve analysis, researchers predicted the need for LT was 0.76 ± 0.1 (P=.04), with a specificity of 73%, sensitivity of 83% and a hazard ratio of 9 (P=.05) for an IgG4 level of more than 70 mg/dL.

“We have demonstrated that a serum IgG4 cut-off value greater than 70 mg/dL may help predict which PSC patients will require liver transplantation,” Farhad Peerani, MD, researcher, division of gastroenterology, University of Alberta, said at the conference. “These findings will need to be validated in larger cohorts at other centers.”

For more information:

Peerani F. #378. Presented at: Digestive Disease Week 2014; May 3-6; Chicago.

Disclosure: Fedorak reports numerous financial disclosures.