Recurrence and rejection in liver transplantation for primary sclerosing cholangitis

Table 1 Studies analyzing recurrence of primary sclerosing cholangitis after liver transplantation

Ref.	Yr	n	Median follow-up(range) in months	Recurrencen (%)	Median time to recurrence (range) in months	Diagnostic criteriafor recurrence	Risk factor(s)for recurrence
Goss et al[11]	1997	127	36 (ND)	11 (8.6)	ND (ND)	Radiographic and histological evidence	ND
Jeyarajah et al[70]	1998	100	ND (12-108)	18 (18)	21 (mean) (ND)	Radiographic and/or histological evidence	ACR
Graziadei et al[87]	1999	120	55 (mean) (4-136)	24 (20)	8.5 (3-42)	Radiographic and/or histological evidence	None
Kubota et al[169]	1999	53	ND (12-156)	3 (5.7)	ND (16-48)	Radiographic and histological evidence	ND
Liden et al[170]	2001	61	ND (ND)	5 (8.2)	ND (ND)	Radiographic and histological evidence	ND
Renz et al[171]	2002	49	66 (ND)	7 (14)	ND (ND)	Radiographic or histological evidence	ND
Yusoff et al[172]	2002	12	58 (mean) (4-174)	2 (17)	ND	Radiographic and histological evidence	ND
Khettry et al[71]	2003	42	ND (24-168)	6 (14.3)	ND (ND)	Radiographic and/or histological evidence	Recipient-donor mismatch
Kugelmas et al[76]	2003	71	ND (14-91)	15 (21.1)	53 (mean) (12-110)	Radiographic or histological evidence	ND
Brandsaeter et al[75]	2005	49	77 (17-182)	9 (18)	ND	Radiographic evidence	Steroid-resistant ACR
Khuroo et al[173]	2005	5	90 (1-186)	2 (40)	ND	Radiographic evidence	ND
Oldakowska-Jedynak et al[174]	2005	17	32 (mean) (0.9-91)	2 (12)	29 (18-51)	Radiographic and/or histological evidence	ND
Cholongitas et al[77]	2007	53	110 (12-185)	7 (13.2)	60 (4-120)	Radiographic and histological evidence	Steroids for UC (> 3 mo post-LTX)
Campsen et al[78]	2007	130	66 (ND)	22 (16.9)	ND (ND)	Radiographic evidence	Pre-LTX CCA
Yamagiwa et al[175]	2007	44 (all LDLT)	ND (ND)	11 (25)	ND (ND)	Radiographic and histological evidence	ND
Tamura et al[176]	2007	8 (LDLT)	42 (ND)	4 (50)	40 (14-66)	Radiographic evidence	ND
Haga et al[74]	2007	22 (all LDLT)	31 (mean) (22-71)	13 (59.1)	31 (22-71)	Radiographic and histological evidence	ND
Alexander et al[69]	2008	69	50 (1-173)	7 (10)	68 (24-134)	Radiographic and/or histological evidence	ACR, steroid resistant ACR, HLA-DRB1*08 in donor or recipient
Alabraba et al[13]	2009	230	82.5 (0.0-239)	54 (23.5)	55.2 (6-155)	Radiographic and histological evidence	Intact colon at the time of LTX, use of EDC graft
Kashyap et al[177]	2009	58	41.5 (mean) (ND)	11 (19)	ND (ND)	Radiographic and/or histological evidence	ND
Egawa et al[73]	2009	20 (all LDLT)	63 (1-133)	11 (55)	ND (26-71)	Radiographic or histological evidence	Cytomegalovirus infection within 3 mo, related donor
Moncrief et al[178]	2009	59	68 (33-106)	15 (25)	40.2 (19.5-66.1)	Radiographic and/or histological evidence	ACR, cytomegalovirus mismatch

LDLT: Live donor liver transplantation; CCA: Cholangiocarcinoma; ND: Not determined; HLA: Human leukocyte antigen; ACR: Acute cellular rejection; LTX: Liver transplantation; EDC: Extended donor criteria; n: No. of patients.

Table 2 Definition of recurrent primary sclerosing cholangitis following liver transplantation (according to Graziadei et al[87])

Diagnosis
Confirmed diagnosis of primary sclerosing cholangitis prior to liver transplantation
And
Cholangiography		Histology
Intrahepatic and/or extrahepatic biliary stricturing, beading, and irregularity > 90 d	Or	Fibrous cholangitis and/or fibro-obliterative lesions with or without ductopenia, biliary fibrosis, or biliary cirrhosis
Exclusion criteria
Hepatic artery thrombosis/stenosis
Established ductopenic rejection
Anastomotic strictures alone
Non Anastomotic strictures before post-transplantation day 90
ABO incompatibility between donor and recipient

Table 3 Studies containing data on the incidence of acute cellular rejection after liver transplantation for primary sclerosing cholangitis

Ref.	Yr	No. ofPSC patients	Median follow-up(range) in months	ACRn (%)	Diagnostic criteria for rejection	Immunosuppression
Klintmalm et al[179]	1988	9	ND (ND)	4 (44)	Biopsy	CyA, CS and azathioprine
McEntee et al[180]	1991	44	ND (ND)	44 (100)	ND	ND
Shaked et al[181]	1992	36	ND (ND)	6 (17)	Biopsy	CyA/Tac, CS and azathioprine
Miki et al[3]	1994	55	ND (ND)	37 (67)	Biopsy	CyA/Tac, CS and azathioprine
Narumi et al[30]	1995	33	37.8 (6-73)	19(57)	Biopsy	ATG for 3-5 d, CS, azathioprine and delayed CyA
Farges et al[131]	1996	23	Minimal follow-up 18 mo	12 (52)	Biopsy	CyA/Tac, CS and azathioprine
Jeyarajah et al[70]	1998	115	Minimal follow-up 12 mo	45 (39)	Biopsy	CyA/Tac, CS and azathioprine
Wiesner et al[130]	1998	126	34	58 (46)	Biopsy	CyA/Tac, CS and azathioprine (1 group received induction with ATG)
Graziadei et al[10]	1999	150	55 (10-138)	103 (69.7)	Biopsy	CyA/Tac, CS and azathioprine
Bathgate et al[182]	2000	16	ND (ND)	10 (63)	Biopsy	ND
Brandsaeter et al[75]	2005	49	77 (17-182)	35 (71)	Biopsy	CyA/Tac, CS and azathioprine/ MMF

PSC: Primary sclerosing cholangitis; ACR: Acute cellular rejection; ND: Not determined; MMF: Mycophenolate mofetil; ATG: Anti-T-lymphocyte Globulin; CyA: Cyclosporine A; Tac: Tacrolimus; CS: Corticosteroid.