Outcome of Liver Retransplantation in Patients With Primary Sclerosing Cholangitis

Overview

Journal Liver Int

Specialty Gastroenterology

Date 2024 Dec 16

PMID 39679639

Authors

Antonio Molinaro

Lise Katrine Engesaeter

Carl Jorns

Arno Nordin

Allan Rasmussen

Pal-Dag Line

Virge Pall

Bo-Goran Ericzon

William Bennet

Johannes R Hov

Espen Melum

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Primary sclerosing cholangitis (PSC) is among the most common indications for liver transplantation in the Nordic countries and with an increasing trend in Europe and North America. Due to post-transplant complications and high prevalence of disease recurrence this group is at risk of requiring retransplantation (re-LTX). Results from re-LTX for PSC are not extensively studied and there is a lack of knowledge regarding prognosis after re-LTX in this population.

Methods: Graft and patient survival after re-LTX for patients with PSC and a comparable comparison group from the Nordic liver transplant registry were analysed. One-hundred and eighty-five patients with PSC and 208 patients in the comparison group were included.

Results: The graft and patient survival were better for patients with PSC compared to the comparison group (p < 0.001). Re-LTX for recurrence of PSC (rPSC) compared to other aetiologies had similar and better outcomes for graft and patient survival (p = 0.093 and p = 0.023, respectively). Moreover, re-LTX for rPSC compared to the comparison group had a lower 30-day and 5-year mortality (p < 0.001 and p = 0.041, respectively).

Conclusion: Outcomes after retransplantation for PSC were similar or better compared to the comparison group. Retransplantation represents a treatment option with the potential for excellent outcomes in patients with PSC and should be considered in transplanted PSC patients with graft failure.

References

Henson J, Patel Y, King L, Zheng J, Chow S, Muir A . Outcomes of liver retransplantation in patients with primary sclerosing cholangitis. Liver Transpl. 2016; 23(6):769-780. PMC: 5865072. DOI: 10.1002/lt.24703. View

Laroche S, Maulat C, Kitano Y, Golse N, Azoulay D, Sa Cunha A . Initial piggyback technique facilitates late liver retransplantation - a retrospective monocentric study. Transpl Int. 2021; 34(5):835-843. DOI: 10.1111/tri.13857. View

Linecker M, Krones T, Berg T, Niemann C, Steadman R, Dutkowski P . Potentially inappropriate liver transplantation in the era of the "sickest first" policy - A search for the upper limits. J Hepatol. 2017; 68(4):798-813. DOI: 10.1016/j.jhep.2017.11.008. View

Rana A, Hardy M, Halazun K, Woodland D, Ratner L, Samstein B . Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transplant. 2008; 8(12):2537-46. DOI: 10.1111/j.1600-6143.2008.02400.x. View

Berenguer M, Di Maira T, Baumann U, Mirza D, Heneghan M, Klempnauer J . Characteristics, Trends, and Outcomes of Liver Transplantation for Primary Sclerosing Cholangitis in Female Versus Male Patients: An Analysis From the European Liver Transplant Registry. Transplantation. 2020; 105(10):2255-2262. DOI: 10.1097/TP.0000000000003542. View

Fosby B, Melum E, Bjoro K, Bennet W, Rasmussen A, Andersen I . Liver transplantation in the Nordic countries - An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982-2013. Scand J Gastroenterol. 2015; 50(6):797-808. PMC: 4487534. DOI: 10.3109/00365521.2015.1036359. View

Murillo Perez C, Ivanics T, Claasen M, Yoon P, Wallace D, Selzner N . Trends in liver transplantation for autoimmune liver diseases: a Canadian study. Can J Surg. 2022; 65(5):E665-E674. PMC: 9564189. DOI: 10.1503/cjs.012121. View

Visseren T, Erler N, Polak W, Adam R, Karam V, Vondran F . Recurrence of primary sclerosing cholangitis after liver transplantation - analysing the European Liver Transplant Registry and beyond. Transpl Int. 2021; 34(8):1455-1467. PMC: 8456806. DOI: 10.1111/tri.13925. View

Graziadei I, Wiesner R, Marotta P, Porayko M, Hay J, Charlton M . Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. Hepatology. 1999; 30(5):1121-7. DOI: 10.1002/hep.510300501. View

10.

Alabraba E, Nightingale P, Gunson B, Hubscher S, Olliff S, Mirza D . A re-evaluation of the risk factors for the recurrence of primary sclerosing cholangitis in liver allografts. Liver Transpl. 2009; 15(3):330-40. DOI: 10.1002/lt.21679. View

11.

Kim W, Lake J, Smith J, Schladt D, Skeans M, Noreen S . OPTN/SRTR 2017 Annual Data Report: Liver. Am J Transplant. 2019; 19 Suppl 2:184-283. DOI: 10.1111/ajt.15276. View

12.

Karlsen T, Folseraas T, Thorburn D, Vesterhus M . Primary sclerosing cholangitis - a comprehensive review. J Hepatol. 2017; 67(6):1298-1323. DOI: 10.1016/j.jhep.2017.07.022. View

13.

Petrowsky H, Rana A, Kaldas F, Sharma A, Hong J, Agopian V . Liver transplantation in highest acuity recipients: identifying factors to avoid futility. Ann Surg. 2013; 259(6):1186-94. DOI: 10.1097/SLA.0000000000000265. View

14.

Morelli M, Gambato M, Martini S, Carrai P, Toniutto P, Giannelli V . Trends in liver transplantation for primary sclerosing cholangitis. Dig Liver Dis. 2024; 56(8):1343-1349. DOI: 10.1016/j.dld.2024.01.175. View

15.

Ravikumar R, Tsochatzis E, Jose S, Allison M, Athale A, Creamer F . Risk factors for recurrent primary sclerosing cholangitis after liver transplantation. J Hepatol. 2015; 63(5):1139-46. DOI: 10.1016/j.jhep.2015.07.005. View

16.

Choe J, Mulligan D . Liver retransplantation: Recurrent primary sclerosing cholangitis may provide better outcomes. Liver Transpl. 2017; 23(6):730-732. DOI: 10.1002/lt.24777. View

17.

Lindstrom L, Jorgensen K, Boberg K, Castedal M, Rasmussen A, Rostved A . Risk factors and prognosis for recurrent primary sclerosing cholangitis after liver transplantation: a Nordic Multicentre Study. Scand J Gastroenterol. 2018; 53(3):297-304. DOI: 10.1080/00365521.2017.1421705. View

18.

Carbone M, Della Penna A, Mazzarelli C, De Martin E, Villard C, Bergquist A . Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)-A European Society of Organ Transplantation (ESOT) Consensus Statement. Transpl Int. 2023; 36:11729. PMC: 10570452. DOI: 10.3389/ti.2023.11729. View

19.

The Lancet Gastroenterology Hepatology . Liver transplantation in the USA: ethical issues. Lancet Gastroenterol Hepatol. 2019; 5(1):1. DOI: 10.1016/S2468-1253(19)30386-3. View

20.

Kim W, Wiesner R, Poterucha J, Therneau T, Malinchoc M, Benson J . Hepatic retransplantation in cholestatic liver disease: impact of the interval to retransplantation on survival and resource utilization. Hepatology. 1999; 30(2):395-400. PMC: 2957088. DOI: 10.1002/hep.510300210. View