title: Recurrent primary sclerosing cholangitis in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study: Comparison of risk factors between living and deceased donor recipients.
abstract: Primary sclerosing cholangitis (PSC) recurs in 15%-25% of patients transplanted for PSC. In the United States, PSC transplant patients are more likely to receive an organ from a living donor (LD) than patients without PSC. Our aims were to (1) compare risk of PSC recurrence in LD versus deceased donor recipients and (2) identify risk factors for PSC recurrence. There were 241 living donor liver transplantations (LDLTs) and 65 deceased donor liver transplantation (DDLT) patients transplanted between 1998 and 2013 enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study who were evaluated. PSC recurrence risk for LDLT and DDLT recipients was compared using Kaplan-Meier survival curves and log-rank tests. Cox models were used to evaluate PSC risk factors. Overall PSC recurrence probabilities were 8.7% and 22.4% at 5 and 10 years after liver transplantation (LT), respectively. The risk of PSC recurrence was not significantly different for DDLT versus LDLT recipients (P = 0.36). For DDLT versus LDLT recipients, unadjusted 5- and 10-year PSC recurrence was 9.4% versus 9.5% and 36.9% versus 21.1%. Higher laboratory Model for End-Stage Liver Disease (MELD) score at LT, onset of a biliary complication, cholangiocarcinoma, and higher donor age were associated with increased risks of PSC recurrence: for MELD (hazard ratio [HR] = 1.06; 95% confidence interval [CI] 1.02-1.10 per MELD point, P = 0.002); for biliary complication (HR, 2.82; 95% CI, 1.28-6.25; P = 0.01); for cholangiocarcinoma (HR, 3.98; 95% CI, 1.43-11.09; P = 0.008); for donor age (per 5-years donor age; HR, 1.17; 95% CI, 1.02-1.35; P = 0.02). Factors not significantly associated with PSC recurrence included the following: first-degree relative donor (P = 0.11), post-LT cytomegalovirus infection (P = 0.38), and acute rejection (P = 0.22). Risk of recurrent PSC was not significantly different for DDLT and LDLT recipients. Biliary complications, cholangiocarcinoma, MELD, and donor age were significantly associated with risk of PSC recurrence. Liver Transplantation 22 1214-1222 2016 AASLD.
authors.affiliation: Department of Hepatobiliary Surgery and Transplantation, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Gordon
authors.affiliation: Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldberg
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Goodrich
authors.affiliation: Department of Internal Medicine-Gastroenterology, University of Michigan, Ann Arbor, MI.
authors.forename: Anna S F
authors.initials: AS
authors.lastname: Lok
authors.affiliation: College of Physicians and Surgeons, Center for Liver Disease and Transplantation, Columbia University, New York, NY.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.affiliation: Multiorgan Transplant Program, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nazia
authors.initials: N
authors.lastname: Selzner
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI.|Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000401:mortality / Q000601:surgery*; D058625:End Stage Liver Disease / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014481:United States