Sun B, Guan D, Gao YG, Chen JY, Rong YH, Guo ZM. Risk factors for recurrence of primary sclerosing cholangitis in pediatric liver transplant recipients: A meta-analysis. World J Gastrointest Surg 2025; 17(6): 103867 [DOI: 10.4240/wjgs.v17.i6.103867]
Corresponding Author of This Article
Yi-Hui Rong, Department of Infectious Diseases, Peking University International Hospital, No. 1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing 102206, China. aihandeye@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Bei Sun, Yi-Hui Rong, Department of Infectious Diseases, Peking University International Hospital, Beijing 102206, China
Dong Guan, Department of Neurosurgery, Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital) Affiliated to Qingdao University, Qingdao 266000, Shandong Province, China
Yu-Geng Gao, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
Jing-Yi Chen, Department of Breast Radiotherapy, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
Zuo-Ming Guo, Department of Hepatobiliary and Pancreatic Surgery, Harbin Medical University Cancer Hospital, Harbin 150040, Heilongjiang Province, China
Co-corresponding authors: Yi-Hui Rong and Zuo-Ming Guo.
Author contributions: Sun B, Rong YH, and Guo ZM designed the experiment and collected the clinical data; Guan D, Gao YG, and Chen JY performed the postoperative follow-up and recorded the data; Sun B, Rong YH, and Guo ZM conducted several collations and statistical analyses; All the authors read and approved the final manuscript. Rong YH and Guo ZM contributed equally to this work and are the co-corresponding authors, as they are involved in the design of the study, the acquisition and analysis of the experimental data, and the writing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Hui Rong, Department of Infectious Diseases, Peking University International Hospital, No. 1 Shengmingyuan Road, Zhongguancun Life Science Park, Changping District, Beijing 102206, China. aihandeye@163.com
Received: January 10, 2025 Revised: March 6, 2025 Accepted: April 28, 2025 Published online: June 27, 2025 Processing time: 140 Days and 2.8 Hours
Abstract
BACKGROUND
Primary sclerosing cholangitis (PSC) is a long-term liver condition defined by the inflammation and scarring of the bile ducts, resulting in complications such as liver cirrhosis, portal hypertension, and cholangiocarcinoma. Although PSC predominantly affects adults, the incidence in pediatric patients is rising. For individuals in the advanced stages of liver disease, liver transplantation (LT) is the sole curative treatment option. However, the recurrence of PSC in the transplanted liver, known as recurrent PSC (rPSC), remains a significant concern.
AIM
To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.
METHODS
A literature search was carried out across databases, including PubMed, Embase, Cochrane Library, and Scopus, covering studies published from 1990 through 2024. The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies. Statistical analyses were conducted using RevMan 5.3 software, where the risk of recurrence was quantified using hazard ratios (HR) with 95%CI.
RESULTS
A total of nine reports with 2524 pediatric patients with PSC were included in this analysis. The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant, including concurrent inflammatory bowel disease (IBD), elevated liver enzyme levels, and the presence of PSC-autoimmune hepatitis (AIH) overlap syndrome (all P < 0.05). No statistically significant association was found between acute allograft rejection, Epstein-Barr virus infection, and the risk of rPSC recurrence in the pediatric liver transplant recipients.
CONCLUSION
The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT, including IBD, elevated liver enzyme levels, and PSC-AIH overlap syndrome.
Core Tip: This meta-analysis identifies risk factors for the recurrence of primary sclerosing cholangitis (PSC) in pediatric patients after liver transplantation. Key findings include the association of concurrent inflammatory bowel disease, elevated liver enzyme levels at the time of liver transplant procedure, and PSC-autoimmune hepatitis overlap syndrome with a higher risk of recurrent PSC. These insights can inform clinical decision-making and patient management strategies for pediatric patients with PSC after transplantation.
