Catanzaro Elisa, Gringeri Enrico, Cazzagon Nora, Floreani Annarosa, Cillo Umberto, Burra Patrizia, Gambato Martina
Multivisceral Transplant Unit and Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy.
Hepatobiliary Surgery and Liver Transplantation Center, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, 35128 Padova, Italy.
J Pers Med. 2024 Feb 20;14(3):222. doi: 10.3390/jpm14030222.
Primary sclerosing cholangitis (PSC), comprising 5-15% of European liver transplantation (LT) cases, poses a significant challenge due to the risk of post-transplant disease recurrence (rPSC). This single-center study aimed to determine the rPSC rate and long-term post-LT outcomes in PSC patients and to identify potentially modifiable risk factors of rPSC.
All PSC patients receiving LT at Padua Hospital from 1993 to 2021 were included. Recipient data were collected pre-LT, at LT, and during the follow-up. Donor and LT features were recorded. The rPSC rate was assessed according to Mayo Clinic criteria. Patient and graft survival were reported.
Thirty-three patients were included. The main indication of LT was decompensated cirrhosis (70%). Nine patients (27%) developed rPSC during a median follow-up of 59 months (45-72). A longer cold ischemia time ( = 0.026), donor female gender ( = 0.049), inflammatory bowel disease reactivation (IBD) post LT ( = 0.005) and hepaticojejunostomy ( = 0.019) were associated with a higher risk of rPSC. Graft and patient survival at 1, 5 and 10 years post LT, 94%, 86%, 74% and 97%, 89%, 77% respectively, were not affected by rPSC development.
Specific donor and surgical features might increase the risk of rPSC. Identifying predictive factors for rPSC to prevent graft loss is challenging but could lead to a more personalized organ allocation and follow-up in PSC transplanted patients. IBD reactivation might have a pathogenic role in rPSC. In our single-center experience, rPSC did not affect patient and graft survival.
原发性硬化性胆管炎（PSC）占欧洲肝移植（LT）病例的5%-15%，由于移植后疾病复发（rPSC）的风险，它构成了一项重大挑战。这项单中心研究旨在确定PSC患者的rPSC发生率和LT后的长期结局，并确定rPSC潜在的可改变风险因素。
纳入1993年至2021年在帕多瓦医院接受LT的所有PSC患者。收集受者LT前、LT时及随访期间的数据。记录供者和LT的特征。根据梅奥诊所标准评估rPSC发生率。报告患者和移植物存活率。
纳入33例患者。LT的主要指征是失代偿性肝硬化（70%）。9例患者（27%）在中位随访59个月（45-72个月）期间发生rPSC。冷缺血时间较长（P=0.026）、供者为女性（P=0.049）、LT后炎症性肠病复发（IBD）（P=0.005）和肝空肠吻合术（P=0.019）与rPSC风险较高相关。LT后1年、5年和10年的移植物和患者存活率分别为94%、86%、74%和97%、89%、77%，不受rPSC发生的影响。
特定的供者和手术特征可能会增加rPSC的风险。识别rPSC的预测因素以防止移植物丢失具有挑战性，但可能会导致PSC移植患者更个性化的器官分配和随访。IBD复发可能在rPSC中起致病作用。根据我们的单中心经验，rPSC不影响患者和移植物存活率。
