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 relies on cholangiographic findings.
• The link between early post-transplant cholestasis and rPSC development is not fully understood.

Purpose of the Study:

• To investigate if cholestasis in the first 12 months post-LT is associated with the development of rPSC.
• To determine if early cholestasis predicts graft loss in LT recipients with PSC.

Main Methods:

• Retrospective cohort analysis of 158 Canadian and 549 UK LT recipients with PSC.
• Evaluation of serum liver tests within 12 months post-LT.
• Cox regression analysis to assess the association between severe cholestasis and rPSC/graft loss.

Main Results:

• Severe cholestasis was more frequent in patients who developed rPSC at 3, 6, and 12 months post-LT in the Canadian cohort, and at 12 months in the UK cohort.
• Development of severe cholestasis at 3 months (Canada) and 12 months (UK) was significantly associated with rPSC.
• Severe cholestasis at 3 months in the Canadian cohort predicted graft loss.

Conclusions:

• Cholestasis developing within 3-12 months following liver transplantation is a significant predictor of recurrent PSC.
• Early post-transplant cholestasis is also associated with an increased risk of graft loss in LT recipients with PSC.