TY - JOUR
T1 - Recurrence of primary sclerosing cholangitis after liver transplantation - analysing the European Liver Transplant Registry and beyond
AU - European Liver Intestine Transplan
AU - Visseren, Thijmen
AU - Erler, Nicole Stephanie
AU - Polak, Wojciech Grzegorz
AU - Adam, Rene
AU - Karam, Vincent
AU - Vondran, Florian Wolfgang Rudolf
AU - Ericzon, Bo-Goran
AU - Thorburn, Douglas
AU - IJzermans, Jan Nicolaas Maria
AU - Paul, Andreas
AU - van der Heide, Frans
AU - Taimr, Pavel
AU - Nemec, Petr
AU - Pirenne, Jacques
AU - Romagnoli, Renato
AU - Metselaar, Herold Johnny
AU - Murad, Sarwa Darwish
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - bayesian statistics
KW - disease recurrence
KW - liver transplantation
KW - patient and graft survival
KW - primary sclerosing cholangitis
KW - RISK-FACTORS
KW - NATURAL-HISTORY
KW - OUTCOMES
KW - EPIDEMIOLOGY
KW - POPULATION
KW - DISEASE
KW - IMPACT
U2 - 10.1111/tri.13925
DO - 10.1111/tri.13925
M3 - Article
SN - 0934-0874
VL - 34
SP - 1455
EP - 1467
JO - Transplant International
JF - Transplant International
IS - 8
ER -