Risk factors for recurrence of primary sclerosing cholangitis in pediatric liver transplant recipients: A meta-analysis.

BACKGROUND

Primary sclerosing cholangitis (PSC) is a long-term liver condition defined by the inflammation and scarring of the bile ducts, resulting in complications such as liver cirrhosis, portal hypertension, and cholangiocarcinoma. Although PSC predominantly affects adults, the incidence in pediatric patients is rising. For individuals in the advanced stages of liver disease, liver transplantation (LT) is the sole curative treatment option. However, the recurrence of PSC in the transplanted liver, known as recurrent PSC (rPSC), remains a significant concern.

AIM

To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.

METHODS

A literature search was carried out across databases, including PubMed, Embase, Cochrane Library, and Scopus, covering studies published from 1990 through 2024. The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies. Statistical analyses were conducted using RevMan 5.3 software, where the risk of recurrence was quantified using hazard ratios (HR) with 95%CI.

RESULTS

A total of nine reports with 2524 pediatric patients with PSC were included in this analysis. The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant, including concurrent inflammatory bowel disease (IBD), elevated liver enzyme levels, and the presence of PSC-autoimmune hepatitis (AIH) overlap syndrome (all < 0.05). No statistically significant association was found between acute allograft rejection, Epstein-Barr virus infection, and the risk of rPSC recurrence in the pediatric liver transplant recipients.

CONCLUSION

The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT, including IBD, elevated liver enzyme levels, and PSC-AIH overlap syndrome.