Postoperative detection of Klebsiella pneumoniae in clinical cultures and recurrent primary sclerosing cholangitis after liver transplantation: a single-center retrospective cohort study.

Recurrent primary sclerosing cholangitis (rPSC) remains a significant challenge. Although Klebsiella pneumoniae (Kp) has been implicated in PSC pathogenesis, its association with rPSC remains unclear. We retrospectively analyzed 62 patients who underwent LT for PSC at our institution between 1996 and July 2024 and survived for more than 1 year. We assessed the association between Kp detection in postoperative clinical cultures and rPSC. rPSC was observed in 22 of 62 patients (35.5%). Kp was detected more frequently in the rPSC group than in the non-rPSC group (31.8% vs. 7.5%). In multivariate Cox regression analysis, Kp detection in clinical cultures (Hazard ratio: 3.83, 95% confidence interval: 1.44-10.21, p = 0.007) and identification of three or more bacterial species in clinical cultures (Hazard ratio: 0.31, 95% confidence interval: 0.12-0.78, p = 0.01) were indpendently associated with rPSC. Recurrence-free survival was significantly shorter in patients with Kp detection (10-year recurrence-free survival: 28% with Kp vs. 56.7% without Kp, p = 0.03). These findings suggest a potential association between postoperative Kp detection and rPSC.