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Primary Sclerosing Cholangitis Recurrence After Liver Transplantation: A Systematic Review and Updated Meta-Analysis
Isabelle Castro Vitor1, Milena Ramos Tomé2, Wellgner Fernandes Oliveira Amador2
1Department of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Summary
Recurrence of primary sclerosing cholangitis (rPSC) after liver transplantation (LT) affects 18.66% worldwide, with higher rates in Oceania. Younger age, male sex, and de novo inflammatory bowel disease are risk factors for rPSC.
Area of Science:
- Hepatology
- Transplantation Immunology
- Gastroenterology
Background:
- Primary sclerosing cholangitis (PSC) is an immune-mediated liver disease requiring liver transplantation (LT) for advanced stages.
- Recurrence of PSC (rPSC) post-LT is a significant challenge, impacting long-term outcomes.
- Understanding the prevalence, incidence, and risk factors for rPSC is crucial for patient management.
Purpose of the Study:
- To systematically assess the global prevalence and incidence of rPSC following LT.
- To identify key factors associated with the occurrence of rPSC after liver transplantation.
Main Methods:
- A systematic review and meta-analysis of observational studies was performed.
- Searches were conducted across PubMed, Embase, and Cochrane databases.
- Statistical analysis utilized a random-effects model with 95% confidence intervals.
Main Results:
- Twenty-nine studies including 4682 patients revealed a worldwide pooled prevalence of rPSC at 18.66% and an incidence of 26.04 per 1000 person-years.
- Oceania reported the highest prevalence (30.65%), while South America had the highest incidence (39.97 per 1000 person-years).
- Factors associated with increased rPSC risk included younger recipient age, male sex, de novo inflammatory bowel disease (IBD), and acute rejection episodes; cyclosporine use was associated with lower risk.
Conclusions:
- The prevalence and incidence of rPSC post-LT demonstrate significant geographical variation.
- Younger recipient age, male sex, de novo IBD, and acute rejection are linked to higher rPSC risk.
- Cyclosporine use post-LT may be associated with a reduced risk of recurrence.
