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Lookup NU author(s): Professor Derek Manas, Gourab Sen
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. Background & Aims: Primary sclerosing cholangitis (PSC) may reoccur following liver transplantation (LT) and the diagnosis established once imaging studies demonstrate the diagnostic cholangiographic appearance. To evaluate whether the development of recurrent PSC (rPSC) is associated with cholestasis soon after LT, we studied whether changes in hepatic biochemistry within the first 12 months were linked with the development of rPSC and graft loss. Methods: We conducted a retrospective cohort analysis of 158 transplant recipients with PSC in Canada, and 549 PSC transplant recipients from the United Kingdom. We evaluated serum liver tests within 12 months after LT and the subsequent development of a cholangiographic diagnosis of rPSC as a time-dependent covariate using Cox regression. Severe cholestasis was defined as either alkaline phosphatase> 3xupper limit of normal or total bilirubin> 100 mol/L. Results: Patients who developed rPSC were more likely to have severe cholestasis versus those without at 3 months (20.5% vs 8.2%, p=0.011), at 6 months (17.9% vs. 10.0%, p=0.026) and 12 months (15.4% vs. 7.8%, p=0.051) in the Canadian cohort and at 12 months in the UK cohort (27.9% vs. 12.6%, p<0.0001). By multivariable analysis, development of severe cholestasis in the Canadian cohort at 3 months (HR=2.41, p=0.046) and in the UK cohort at 12 months (HR=3.141, p<0.0001) were both associated with rPSC. Severe cholestasis at 3 months in the Canadian cohort was predictive of graft loss (HR=3.88, p=0.0001). Conclusions: The development of cholestasis within 3 to 12 months following LT was predictive of rPSC and graft loss.
Author(s): Aziz B, Kok B, Cheah M, Lytvyak E, Moctezuma-Velazquez C, Wasilenko S, Tsochatzis E, Ravikumar R, Jose S, Allison M, Gunson B, Manas D, Monaco A, Mirza D, Fusai G, Owen N, Thorburn D, Roberts K, Srinivasan P, Wigmore S, Athale A, Creamer F, Fernando B, Iyer V, Madanur M, Sen G, Montano-Loza AJ, Hansen B, Mason AL
Publication type: Article
Publication status: Published
Journal: American Journal of Gastroenterology
Year: 2024
Pages: ePub ahead of Print
Online publication date: 25/07/2024
Acceptance date: 09/05/2024
Date deposited: 06/08/2024
ISSN (print): 0002-9270
ISSN (electronic): 1572-0241
Publisher: Wolters Kluwer Health
URL: https://doi.org/10.14309/ajg.0000000000002977
DOI: 10.14309/ajg.0000000000002977
PubMed id: 39052775
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