title: Risk factors for recurrent primary sclerosing cholangitis after liver transplantation.
abstract: OBJECTIVE
  The association between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) is well recognised. However, the relationship between IBD and recurrent PSC (rPSC) is less well understood. We assessed the prevalence of rPSC and analysed the factors associated with rPSC post-liver transplantation and its influence on graft and patient survival.
  
  
  METHODS
  This is a UK multicentre observational cohort study across six of the seven national liver transplant units. All patients undergoing a first liver transplant for PSC between January 1 1990 and December 31 2010 were included. Prospectively collected liver transplant data was obtained from NHSBT and colitis data was retrospectively collected from individual units.
  
  
  RESULTS
  There were 679 (8.8%) first transplants for PSC. 347 patients (61.4%) had IBD, of which 306 (88.2%) had ulcerative colitis (UC). 81 (14.3%) patients developed rPSC and 37 (48.7%) of them developed graft failure from rPSC. Presence of UC post-liver transplant (HR=2.40, 95% CI 1.44-4.02) and younger age (HR=0.78, 95% CI 0.66-0.93) were the only factors significantly associated with rPSC. rPSC was associated with over a 4-fold increase in the risk of death (HR=4.71, 95% CI 3.39, 6.56) with 1, 5, and 10-year graft survival rates of 98%, 84%, and 56% respectively compared to 95%, 88%, and 72% in patients who did not develop rPSC.
  
  
  CONCLUSIONS
  The presence of UC post-liver transplant is associated with a significantly increased risk of rPSC. Furthermore, the presence of rPSC increases the rate of graft failure and death, with higher re-transplantation rates.
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK. Electronic address: Reena.ravikumar@nhs.net.
authors.forename: Reena
authors.initials: R
authors.lastname: Ravikumar
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.affiliation: Research Department of Infection and Population Health, University College London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jose
authors.affiliation: Cambridge Transplant Unit, Cambridge University Hospitals, Cambridge, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Allison
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, UK.
authors.forename: Anuja
authors.initials: A
authors.lastname: Athale
authors.affiliation: Department of HPB and Liver Transplant Surgery, Royal Infirmary of Edinburgh, UK.
authors.forename: Felicity
authors.initials: F
authors.lastname: Creamer
authors.affiliation: The Liver Unit, University Hospital Birmingham, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Gunson
authors.affiliation: The Liver Unit, University Hospital Birmingham, UK.
authors.forename: Vikram
authors.initials: V
authors.lastname: Iyer
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, UK.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Madanur
authors.affiliation: Institute of Transplantation, Freeman Hospital, Newcastle, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Manas
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Monaco
authors.affiliation: The Liver Unit, University Hospital Birmingham, UK.
authors.forename: Darius
authors.initials: D
authors.lastname: Mirza
authors.affiliation: Cambridge Transplant Unit, Cambridge University Hospitals, Cambridge, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Owen
authors.affiliation: The Liver Unit, University Hospital Birmingham, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Roberts
authors.affiliation: Institute of Transplantation, Freeman Hospital, Newcastle, UK.
authors.forename: Gourab
authors.initials: G
authors.lastname: Sen
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, UK.
authors.forename: Parthi
authors.initials: P
authors.lastname: Srinivasan
authors.affiliation: Institute of Transplantation, Freeman Hospital, Newcastle, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Wigmore
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fusai
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
authors.forename: Bimbi
authors.initials: B
authors.lastname: Fernando
authors.affiliation: Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
keywords: Colectomy; Liver transplantation; Patients and graft survival; Recurrent PSC; Ulcerative colitis