Risk of recurrence of primary sclerosing cholangitis after liver transplantation is associated with de novo inflammatory bowel disease

Table 1 Demographic characteristics, transplant population, and study cohort n (%)

	Patients transplanted for PSC (n = 121)	Study cohort (n = 47)
Sex, recipients; male/female	88/33 (72.7/27.3)	31/16 (66/34)
Median age, recipient, yr (range)	36 (12-64)	36 (12-60)
Median age, donor, yr (range)	34 (2-66)	37 (10-61)
Median follow-up, mos (range)	87 (0-249)	116 (60-249)
MELD score at time of OLT, median (range)	15 (6-34)	15 (8-32)
Overlap syndrome AIH/PSC pre-OLT	20 (16.5)	5 (10.6)
Graft configuration: whole/reduced	116/5 (95.9/4.1)	47/0 (100/0)
Cholangiocarcinoma in liver explant	8 (6.6)	0 (0)
Cold ischemia median time, min (range)	300 (125-637)	319 (175-637)
Type of anastomosis: End-to-end/Roux-en-Y	31/90 (25.6/74.4)	7/40 (14.9/85.1)
Tacrolimus-based primary immunosuppressive regimen	92 (76.0)	32 (68.1)
Cyclosporine-based primary immunosuppressive regimen	29 (24.0)	15 (31.9)
IBD pre-OLT	76 (62.8)	29 (61.7)
UC	75 (98.7)	29 (100)
CD	1 (1.3)	0 (0)
Indeterminate colitis	0 (0)	0 (0)
Mild course of IBD pre-OLT	62 (81.6)	29 (100)
Active course of IBD pre-OLT	14 (18.4)	0 (0)
Colectomy pre-OLT	4 (3.3)	-
Liver retransplantation, total	15 (12.4)	7 (14.9)
Liver retransplantation, for rPSC	8 (6.6)	6 (12.8)

PSC: Primary sclerosing cholangitis; OLT: Orthotopic liver transplantation; AIH: Autoimmune hepatitis; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn´s disease; rPSC: Recurrent PSC.

Table 2 Univariate analysis of risk factors for recurrent primary sclerosing cholangitis n (%)

	Total (n = 47)	rPSC (n = 21)	No rPSC (n = 26)	P value
De novo IBD post-OLT,	12 (25.5)	11 (91.7)	1 (8.3)	0.011
IBD pre-OLT	29 (61.7)	8 (27.6)	21 (72.4)	0.825
No colitis (pre-OLT or post-OLT)	6 (12.8)	2 (33.3)	4 (66.7)	0.678
Median age, recipient, yr (range)	36 (12-60)	35 (12-60)	38 (20-60)	0.337
Median age, donor, yr (range)	37 (11-61)	37 (11-60)	40.5 (13-61)	0.245
Male; female, recipient	31; 16 (66.0; 34.0)	12; 9 (38.7; 56.3)	19; 7 (61.3; 43.8)	0.355
Male; female, donor	24; 23 (51.1; 48.9)	13; 8 (54.2; 34.8)	11; 15 (45.8; 65.2)	0.244
Sex mismatch	23 (48.9)	11 (47.8)	12 (52.2)	0.773
MELD score at time of OLT (range)	15 (6-32)	15 (8-30)	15 (6-32)	0.773
History of ACR	25 (53.2)	14 (56.0)	11 (44.0)	0.114
Multiple episodes of ACR	12 (25.5)	7 (58.3)	5 (41.7)	0.326
Corticoresistant ACR	6 (12.8)	3 (50.0)	3 (50.0)	0.665
ACR treated with OKT3	4 (8.5)	3 (75.0)	1 (25.0)	0.615
ACR treated with ATG	2 (4.3)	0 (0)	2 (100)	0.163
CMV IgG positivity, recipient	27 (57.5)	12 (44.4)	15 (55.6)	1.000
CMV IgG positivity, donor	36 (76.6)	18 (50.0)	18 (50.0)	0.300
Corticosteroid administration ≥ 3 mo post-OLT	43 (91.5)	18 (41.9)	25 (58.1)	0.311
Corticosteroid administration ≥ 6 mo post-OLT	41 (87.2)	17 (41.5)	24 (58.5)	0.386
Corticosteroid administration ≥ 3 mo post-OLT with dose ≥ 10 mg prednisone	28 (59.6)	14 (50.0)	14 (50.0)	0.551
Corticosteroid administration ≥ 6 mo post-OLT with dose ≥ 10 mg prednisone	13 (27.7)	5 (68.5)	8 (61.5)	0.747
Overlap with AIH pre-OLT	5 (10.6)	5 (100)	0 (0)	0.013
Type of anastomosis: End-to-end; Roux-en-Y	7; 40 (14.9; 85.1)	4; 17 (57.1; 42.5)	3; 23 (42.9; 57.5)	0.684
Liver steatosis, donor	11 (23.4)	6 (54.6)	5 (45.5)	0.505
Cold ischemia median time, min (range)	320 (175-637)	315 (206-618)	324 (175-637)	0.627

rPSC: Recurrent primary sclerosing cholangitis; OLT: Orthotopic liver transplantation; ATG: (Rabbit) antithymocyte globulin; AIH: Autoimmune hepatitis; IBD: Inflammatory bowel disease; ACR: Acute cellular rejection; CMV: Cytomegalovirus.

Table 3 Human leukocyte antigen-DRB1* and human leukocyte antigen-DQB1* alleles in donors and recipients, association with recurrent primary sclerosing cholangitis n (%)

	Donor	rPSC	P value	Recipient	rPSC	P value
HLA-DRB1*
1	5	2 (40.0)	1.000	9	3 (33.3)	0.711
3	7	2 (28.6)	0.427	23	11 (47.8)	0.767
4	9	4 (44.4)	1.000	6	0 (0)	0.029
5	1	1 (100)	0.450
6	2	2 (100)	0.196
7	15	10 (66.7)	0.050	2	0 (0)	0.498
8	2	1 (50.0)	1.000
9	1	0 (0)	1.000	1	1 (100)	0.435
10				1	1 (100)	0.435
11	10	4 (40.0)	1.000	5	1 (20.0)	0.369
12	2	2 (100)	0.196	1	1 (100)	0.435
13	8	2 (25.0)	0.258	10	5 (50.0)	0.726
14	4	0 (0)	0.114	1	1 (100)	0.435
15	8	3 (37.5)	0.709	15	5 (33.3)	0.365
16	1	1 (100)	0.450	3	2 (66.7)	0.572
HLA-DQB1*
2	17	9 (53.0)	0.740	25	10 (40.0)	1.000
3	20	8 (40.0)	0.740	11	1 (9.1)	0.030
7	15	6 (40.0)	0.500	7	0 (0)	0.031
8	7	5 (71.4)	0.229	4	0 (0)	0.140
9	2	1 (50.0)	1.000	1	1 (100)	0.395
4	2	1 (50.0)	1.000
5	9	4 (44.4)	1.000	10	5 (50.0)	0.481
6	13	4 (30.8)	0.164	21	9 (42.9)	0.760

rPSC: Recurrent primary sclerosing cholangitis.