Severe Cholestasis Predicts Recurrent Primary Sclerosing Cholangitis Following Liver Transplantation

Area of Science:

• Hepatology
• Transplant Surgery
• Gastroenterology

Background:

• Primary sclerosing cholangitis (PSC) can recur after liver transplantation (LT).
• Recurrent PSC (rPSC) diagnosis is based on cholangiographic findings.
• The association between early post-LT cholestasis and rPSC development requires investigation.

Purpose of the Study:

• To determine if cholestasis developing within 12 months post-LT is linked to rPSC.
• To evaluate the association between early cholestasis and graft loss after LT in PSC patients.

Main Methods:

• Retrospective cohort analysis of PSC patients undergoing LT in Canada (n=158) and the UK (n=549).
• Serum liver tests were analyzed within 12 months post-LT.
• Cox regression was used to assess the link between severe cholestasis and rPSC development, with severe cholestasis defined by elevated alkaline phosphatase or total bilirubin.

Main Results:

• Patients who developed rPSC showed significantly higher rates of severe cholestasis at 3, 6, and 12 months post-LT compared to those without rPSC.
• Multivariable analysis confirmed severe cholestasis at 3 months (Canada) and 12 months (UK) as predictors of rPSC.
• Severe cholestasis at 3 months in the Canadian cohort was also a significant predictor of graft loss.

Conclusions:

• Development of cholestasis within the first year after LT is a significant predictor of rPSC.
• Early cholestasis post-LT is associated with an increased risk of graft loss in PSC patients.
• Monitoring hepatic biochemistry in the early post-transplant period is crucial for identifying patients at risk for rPSC and graft loss.