Liver Transplant in Primary Sclerosing Cholangitis: Results in Our Center

Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by inflammation and subsequent fibrosis of the intrahepatic and extrahepatic bile ducts. Its clinical course is variable and may progress to advanced cirrhosis, requiring liver transplantation as the treatment of choice. At our center, we conducted a retrospective observational study of patients who underwent liver transplantation due to PSC between 1998 and 2024. The objectives were to evaluate post-transplant survival, identify the most frequent cause of mortality, determine the incidence of incidental cholangiocarcinoma (CCA) in the explanted organ, and assess the recurrence of the underlying disease. Out of a total of 1,507 liver transplant recipients, 1.53% (n = 23) underwent transplantation due to PSC. Five-year survival was 87%, decreasing to 73% at 10 years. The most frequent cause of mortality was de novo tumors (50%, n = 4). With regard to the incidence of incidental CCA in the explanted organs, no cases were identified. Disease recurrence after transplantation occurred in 17.4% (n = 4). In conclusion, our study highlights that, although no cases of incidental CCA were observed in the explanted livers of our cohort, this does not imply any change in the well-documented risk of developing CCA in PSC patients reported in the literature. The recurrence rate of PSC after transplantation was consistent with published data, and overall survival exceeded 70% at 10 years post-transplant.