Recurrent PSC in the A2ALL Study: Comparison of Risk Factors Between Living and Deceased Donor Recipients

Abstract

Background

Primary sclerosing cholangitis (PSC) recurs in 15%–25% of patients transplanted for PSC. In the United States, PSC transplant patients are more likely to receive an organ from a living donor (LD) than patients without PSC. Our aims were to: 1) compare risk of PSC recurrence in LD versus deceased donor (DD) recipients; and 2) identify risk factors for PSC recurrence.

Methods

241 LD liver transplant (LT) and 65 DDLT subjects transplanted between 1998 and 2013 enrolled in the Adult to Adult Living Donor Liver Transplantation Cohort Study were evaluated. PSC recurrence risk for LDLT and DDLT recipients was compared using Kaplan-Meier survival curves and log-rank test. Cox models were used to evaluate PSC Risk factors.

Results

Overall PSC recurrence probabilities were 8.7% and 22.4% at 5 and 10 years post-LT, respectively. The risk of PSC recurrence was not significantly different for DDLT versus LDLT recipients (p=0.36). For DDLT versus LDLT recipients, unadjusted 5- and 10-year PSC recurrence was 9.4% versus 9.5% and 36.9% versus 21.1%. Higher lab Model for End-Stage Liver Disease (MELD) at LT, onset of a biliary complication, cholangiocarcinoma, and higher donor age were associated with increased risk of PSC recurrence (hazard ratio [HR]=1.06, 95% confidence interval [CI] 1.02–1.10 per MELD point, p=0.002; HR=2.82, CI 1.28–6.25 for biliary complication, p=0.01; HR=3.98, CI 1.43–11.09 for cholangiocarcinoma, p=0.008; HR=1.17, CI 1.02–1.35 per 5-years donor age, p=0.02). Factors not significantly associated with PSC recurrence: First-degree relative donor (p=0.11), post-LT cytomegalovirus infection (p=0.29), and acute rejection (p=0.37).

Conclusion

Risk of recurrent PSC was not significantly different for DDLT and LDLT recipients. Biliary complications, cholangiocarcinoma, MELD, and donor age were significantly associated with risk of PSC recurrence.