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A re-evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts

Authors

  • Edward Alabraba,

    1. Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
    2. University of Birmingham, Birmingham, United Kingdom
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  • Peter Nightingale,

    1. Wellcome Trust Clinical Research Facility, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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  • Bridget Gunson,

    1. Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
    2. University of Birmingham, Birmingham, United Kingdom
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  • Stefan Hubscher,

    1. Department of Pathology, University of Birmingham, Birmingham, United Kingdom
    2. University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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  • Simon Olliff,

    1. Department of Radiology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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  • Darius Mirza,

    1. Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
    2. University of Birmingham, Birmingham, United Kingdom
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  • James Neuberger

    Corresponding author
    1. Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
    2. University of Birmingham, Birmingham, United Kingdom
    • Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
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    • Telephone: +44 121 627 2414; FAX: +44 121 627 2449


Abstract

Previously, we have found that the absence of the colon after liver transplantation (LT) protects the patient from recurrent primary sclerosing cholangitis (rPSC). As our previous observation has not been confirmed in other series, we have reviewed our cohort of patients grafted for primary sclerosing cholangitis (PSC) with greater numbers and longer follow-up to reassess the rate, consequences, and risk factors for rPSC. We collected data on patients who underwent LT for PSC between January 1986 and April 2006. Data were collected for cytomegalovirus status, inflammatory bowel disease status, time of colectomy, type of colectomy, donor-recipient gender mismatch, recipient sex, extended donor criteria (EDC), and donor risk index. Accepted criteria were used to diagnose rPSC. Of a total of 230 consecutive adult patients, 61 (27%) underwent colectomy pre-/peri-LT, and 54 (23.5%) developed rPSC at a median of 4.6 (range, 0.5–12.9) years post-LT. A total of 263 deceased donor grafts were used, and 73 were EDC grafts. A diagnosis of rPSC was made in 61 of the 263 grafts (23%). The recurrence-free patient survival was significantly better (P < 0.05) in patients who underwent pre-/peri-LT colectomy and in those with non-EDC grafts. In conclusion, in this larger cohort of 230 patients and with longer follow-up of 82.5 (range, 0.0–238.6) months [in comparison with the previous report of 152 recipients with a follow-up of 52.8 (range, 1–146) months], we have shown that colectomy remains a significant risk factor for rPSC and that colectomy before and during initial LT for PSC confers a protective effect against rPSC in subsequent graft(s). Moreover, we have shown that EDC grafts are also a significant risk factor for rPSC. Liver Transpl 15:330–340, 2009. © 2009 AASLD.

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