Ueda Yoshihide, Kaido Toshimi, Okajima Hideaki, Hata Koichiro, Anazawa Takayuki, Yoshizawa Atsushi, Yagi Shintaro, Taura Kojiro, Masui Toshihiko, Yamashiki Noriyo, Haga Hironori, Nagao Miki, Marusawa Hiroyuki, Seno Hiroshi, Uemoto Shinji
Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan.
Department of Surgery, Kyoto University, Kyoto, Japan.
Transplant Direct. 2017 Nov 20;3(12):e334. doi: 10.1097/TXD.0000000000000751. eCollection 2017 Dec.
Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease, with liver transplantation being the sole life-saving treatment for end-stage PSC-related liver disease. However, recurrence of PSC after liver transplantation is a common complication, with the risk factors for recurrence being controversial.
We conducted a retrospective chart review of 45 patients who had undergone liver transplantation for PSC at our institute. The risk factors for PSC recurrence and graft failure after liver transplantation were analyzed.
The graft survival rates were 55.4% at 5 years and 32.8% at 10 years after liver transplantation for PSC. PSC recurrence was diagnosed in 16 (40%) of 40 patients, at a median 30 months (range, 9-70 months) after liver transplantation. The cumulative incidence rate of PSC recurrence was 24.5% at 3 years, 39.3% at 5 years, and 45.8% at 6 years. Among the 16 patients diagnosed with PSC recurrence, the graft survival rate was 56.3% at 5 years, and 21.9% at 10 years after the recurrence. Active inflammatory bowel disease after liver transplantation was identified as an independent risk factor for PSC recurrence. Age younger than 30 years at the time of PSC diagnosis and bacteremia were factors significantly associated with graft failure after liver transplantation on multivariate analysis.
PSC frequently recurred and progressed to graft failure after liver transplantation for PSC. Maintaining an inactive status of inflammatory bowel disease might offer protection against PSC recurrence.
原发性硬化性胆管炎（PSC）是一种进行性胆汁淤积性肝病，肝移植是终末期PSC相关肝病唯一的挽救生命的治疗方法。然而，肝移植后PSC复发是一种常见并发症，复发的危险因素存在争议。
我们对在我院接受PSC肝移植的45例患者进行了回顾性病历审查。分析了肝移植后PSC复发和移植物失败的危险因素。
PSC肝移植后5年移植物生存率为55.4%，10年为32.8%。40例患者中有16例（40%）被诊断为PSC复发，肝移植后中位时间为30个月（范围9 - 70个月）。PSC复发的累积发生率在3年时为24.5%，5年时为39.3%，6年时为45.8%。在16例诊断为PSC复发的患者中，复发后5年移植物生存率为56.3%，10年为21.9%。肝移植后活动性炎症性肠病被确定为PSC复发的独立危险因素。多因素分析显示，PSC诊断时年龄小于30岁和菌血症是肝移植后移植物失败的显著相关因素。
PSC肝移植后PSC常复发并进展为移植物失败。维持炎症性肠病的非活动状态可能预防PSC复发。
