Recurrence of Primary Sclerosing Cholangitis After Liver Transplantation: A French National Cohort Study Including 571 Patients.

INTRODUCTION

Primary sclerosing cholangitis (PSC) may recur after liver transplantation (LT). We aimed to evaluate the incidence of recurrent PSC (rPSC), its characteristics, and risk factors, in a large cohort with long-term follow-up.

METHODS

We conducted a nationwide multicenter retrospective study in France, including all adult patients transplanted for PSC from March 1985 to March 2019. Clinical, biological, and histological data were collected. Risk factors for rPSC were identified using a multivariate Cox-regression model.

RESULTS

Five hundred seventy-one patients were included (389 males, 68.1%) with a median age at LT of 42.0 (interquartile range [IQR] 32.0-52.8). Median follow-up after LT was 7.4 years (IQR 3.6-12.6). Overall, rPSC occurred in 25.9% of patients; actuarial risk of developing rPSC at 5, 15, and 25 years was 15.6%, 37.9%, and 52.6%, respectively. The median time to rPSC was 4.9 years (IQR 2.3-8.9). The factors independently associated with rPSC were the presence of IBD (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.24-3.14), maintenance treatment with corticosteroids (HR 1.76, 95% CI 1.17-2.66), and younger age at LT (HR 1.02 per 1-year increase, 95% CI 1.01-1.03). Type of biliary anastomosis or preventive treatment with ursodeoxycholic acid had no impact on the incidence of rPSC.

DISCUSSION: Our results from a large cohort with long-term follow-up strongly confirm that rPSC after LT is frequent. The only modifiable factor associated with rPSC was maintenance treatment with corticosteroids, which could therefore be discontinued in the absence of a specific extrahepatic indication.