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UC associated with recurrent primary sclerosing cholangitis post-transplant

Researchers in the United Kingdom found that ulcerative colitis was associated with an increased risk for recurrent primary sclerosing cholangitis after liver transplantation, according to study findings.

In an observational cohort study, 679 patients who underwent liver transplant for primary sclerosing cholangitis (PSC) between January 1990 and December 2010 were included and underwent analysis to assess factors associated with recurrent PSC (rPSC), the influence of ulcerative colitis (UC) on rPSC and how graft and patient survival are impacted by rPSC.

“The factors associated with post-transplant recurrence are [currently] unclear. When patients with UC/PSC are transplanted for PSC, the number and severity of UC flares increase post-transplant,” the researchers wrote. “On the other hand, colectomy in patients with PSC/UC has no effect on liver biochemistry or patient survival in the pretransplant setting.”

Among the patients, the median age at transplant was 49 years, 347 patients had inflammatory bowel disease and 306 had UC. Of these, 565 were included in the final analysis.

Overall, 14.3% of patients developed rPSC (n = 81) and 48.7% of them developed graft failure from rPSC (n = 37).

Multivariate analyses showed that recurrent PSC was associated with a more than fourfold increase in risk of death (HR = 4.71; 95% CI, 3.39-6.56) and UC post-transplant was not associated with patient survival after first transplant (HR = 0.9; 95% CI, 0.64-1.27).

The graft survival rates among patients with rPSC were lower compared with patients without rPSC. The graft survival rate in rPSC patients was 98% at 1 year, 84% at 5 years and 56% at 10 years. The graft survival rate in patients without rPSC was 95% at 1 year, 88% at 5 years and 72% at 10 years.

Factors associated with rPSC included evidence of UC post-liver transplant (HR = 2.4; 95% CI, 1.44-4.02) and younger age (HR = 0.78; 95% CI, 0.66-0.93).

Among patients with rPSC, the time between transplant and rPSC diagnosis was not associated with patient survival (HR = 0.92; 95% CI, 0.81-1.03 per year since transplantation); however, it was associated with graft survival (HR = 0.85; 95% CI, 0.78-0.92) and the combined endpoint of graft failure or mortality (HR = 0.84; 95% CI, 0.77-0.92).

The researchers concluded: “To suggest that all patients with UC undergo a preliver transplant colectomy is contentious, but it is certainly an option that should be considered. Further detailed prospective longitudinal observation studies to assess the impact of severity of colitis on rPSC are required.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.