Recurrent sclerosing cholangitis post-transplant: increased recurrence rates following re-transplantation

Sclerosing cholangitis recurs in some patients following liver transplantation. These high-risk patients may provide clues to the pathogenesis of this disease.

In this single-center study, from a high prevalence area, we investigated the incidence of recurrent sclerosing cholangitis following liver transplantation and re-transplantation.

A retrospective cohort study of all patients with primary sclerosing cholangitis transplanted in the Irish National Liver Transplant program between 1993 and 2019.

Recurrent sclerosing cholangitis occurred in 23/112 patients (20.7%). Overall patient survival was similar in the recurrence and non-recurrence groups. Nine patients were re-transplanted for recurrent disease. Patients with recurrence were significantly younger (42.7 +  - 2.5 years vs. 49.3 +  - 1.3 p < 0.05), and colectomy post-transplant was performed more frequently in the recurrence group (6/21 vs. 9/81 p < 0.05). Further recurrence after re-transplantation was identified in 6/9 patients and was identified a shorter time after transplant than the first recurrence (median 41.5 months; range 26-53 vs. median 65.5; range 38: p < 0.05).

Recurrent PSC following liver transplantation is common, particularly in younger patients. It occurs earlier and is more frequent following a second transplant.