Outcome of Liver Retransplantation in Patients With Primary Sclerosing Cholangitis

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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.

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Most cited references 21

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Primary sclerosing cholangitis – a comprehensive review

Tom H. Karlsen, Trine Folseraas, Douglas Thorburn … (2017)

Primary sclerosing cholangitis (PSC) is a rare disorder characterised by multi-focal bile duct strictures and progressive liver disease. Inflammatory bowel disease is usually present and there is a high risk of cholangiocarcinoma and colorectal cancer. Most patients ultimately require liver transplantation, after which disease recurrence may occur. With limited therapeutic options and a lack of proven surveillance strategies, patients currently have significant unmet needs. In the present seminar, we provide a comprehensive review of the status of the field. We emphasise developments related to patient stratification and disease behaviour, and provide an overview of management options from a practical, patient-centered perspective. We survey advances made in the understanding of PSC pathogenesis and summarise the ongoing efforts to develop an effective therapy based on these insights.

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Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation.

A Rana, M A Hardy, K J Halazun … (2008)

It is critical to balance waitlist mortality against posttransplant mortality. Our objective was to devise a scoring system that predicts recipient survival at 3 months following liver transplantation to complement MELD-predicted waitlist mortality. Univariate and multivariate analysis on 21,673 liver transplant recipients identified independent recipient and donor risk factors for posttransplant mortality. A retrospective analysis conducted on 30,321 waitlisted candidates reevaluated the predictive ability of the Model for End-Stage Liver Disease (MELD) score. We identified 13 recipient factors, 4 donor factors and 2 operative factors (warm and cold ischemia) as significant predictors of recipient mortality following liver transplantation at 3 months. The Survival Outcomes Following Liver Transplant (SOFT) Score utilized 18 risk factors (excluding warm ischemia) to successfully predict 3-month recipient survival following liver transplantation. This analysis represents a study of waitlisted candidates and transplant recipients of liver allografts after the MELD score was implemented. Unlike MELD, the SOFT score can accurately predict 3-month survival following liver transplantation. The most significant risk factors were previous transplantation and life support pretransplant. The SOFT score can help clinicians determine in real time which candidates should be transplanted with which allografts. Combined with MELD, SOFT can better quantify survival benefit for individual transplant procedures.

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OPTN/SRTR 2017 Annual Data Report: Liver

W R Kim, J R Lake, J. M. Smith … (2019)

Data on adult liver transplants performed in the US in 2017 are notable for (1) continued growth in numbers of new waitlist registrants (11,514) and of transplants performed (8,082); (2) continued increase in the transplant rate (51.5 per 100 waitlist-years); (3) a precipitous decrease in waitlist registrations and transplants for hepatitis C-related indications; (4) reciprocal increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non-alcoholic fatty liver disease; and (5) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity. Variability in transplant rates remained by candidate race, presence of hepatocellular carcinoma, urgency status (status 1A versus model for end-stage liver disease (MELD) score >35), and geography. More than half of all children listed for liver transplant in 2017 were aged younger than 5 years in 2017, and the highest rate of pretransplant mortality persisted for children aged younger than 1 year. Children underwent transplant at higher acuity than the past, as evidenced by higher MELD/pediatric end-stage liver disease scores and listings at status 1A and 1B. Higher acuity at transplant is likely due to lack of access to suitable donor organs, which has been compensated for by persistent trends toward use of partial or split liver grafts and ABO-incompatible grafts. Despite higher illness severity scores at transplant, pediatric graft and patient survival posttransplant have improved over time.

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Author and article information

Contributors

Espen Melum:

ORCID: https://orcid.org/0000-0001-6903-6878

espen.melum@medisin.uio.no

Journal

Journal ID (nlm-ta): Liver Int

Journal ID (iso-abbrev): Liver Int

Journal ID (doi): 10.1111/(ISSN)1478-3231

Journal ID (publisher-id): LIV

Title: Liver International

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1478-3223

ISSN (Electronic): 1478-3231

Publication date (Electronic): 16 December 2024

Publication date (Print): January 2025

Volume: 45

Issue: 1 ( doiID: 10.1111/liv.v45.1 )

Electronic Location Identifier: e16214

Affiliations

[ ¹ ] Department of Molecular and Clinical Medicine, Wallenberg Laboratory University of Gothenburg Gothenburg Sweden

[ ² ] Norwegian PSC Research Center, Division of Surgery and Specialized Medicine Oslo University Hospital Oslo Norway

[ ³ ] Research Institute of Internal Medicine, Division of Surgery and Specialized Medicine Oslo University Hospital Oslo Norway

[ ⁴ ] Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway

[ ⁵ ] Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery and Specialized Medicine Oslo University Hospital Oslo Norway

[ ⁶ ] Division of Transplantation Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet Karolinska University Hospital Stockholm Sweden

[ ⁷ ] Department of Transplantation and Liver Surgery University Hospital Helsinki Finland

[ ⁸ ] Department of Surgical Gastroenterology and Liver Transplantation, Rigshospitalet University of Copenhagen Copenhagen Denmark

[ ⁹ ] Section of Transplantation Surgery, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation Oslo University Hospital Oslo Norway

[ ¹⁰ ] Transplantation Centre Tartu University Hospital Tartu Estonia

[ ¹¹ ] Transplant Institute, Sahlgrenska University Hospital The Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden

[ ¹² ] Hybrid Technology Hub‐Centre of Excellence, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo Oslo Norway

Author notes

[*] [* ] Correspondence:

Espen Melum ( espen.melum@ 123456medisin.uio.no )

Author information

Antonio Molinaro https://orcid.org/0000-0003-3432-2238

Carl Jorns https://orcid.org/0000-0001-7727-8113

Johannes R. Hov https://orcid.org/0000-0002-5900-8096

Espen Melum https://orcid.org/0000-0001-6903-6878

Article

Publisher ID: LIV16214 Other ID: LIVint-24-00920.R2

DOI: 10.1111/liv.16214

PMC ID: 11648066

PubMed ID: 39679639

SO-VID: 4f046d4b-a276-45cc-9d99-8b0ed536b922

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

History

Date revision received : 27 November 2024

Date received : 07 May 2024

Date accepted : 02 December 2024

Page count

Figures: 4, Tables: 3, Pages: 10, Words: 5500

Funding

Funded by: Swedish state under the agreement between the Swedish government and the county councils, the ALF‐agreement (ALFGBG‐934173)

Funded by: ERC grant (no. 802544)

Funded by: Regional Healthy Authorities South‐Eastern Norway (no. 2017022)

Custom metadata

source-schema-version-number 2.0

cover-date January 2025

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.1 mode:remove_FC converted:16.12.2024

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: liver transplantation,primary sclerosing cholangitis,retransplantation

Data availability:

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: liver transplantation, primary sclerosing cholangitis, retransplantation

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Outcome of Liver Retransplantation in Patients With Primary Sclerosing Cholangitis

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ABSTRACT

Background and Aims

Methods

Results

Conclusion

Related collections

Karger: Gastroenterology

Most cited references 21

Primary sclerosing cholangitis – a comprehensive review

Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation.

OPTN/SRTR 2017 Annual Data Report: Liver

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