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Meta-Analysis
. 2019 Mar;49(6):636-643.
doi: 10.1111/apt.15148. Epub 2019 Feb 10.

Systematic review with meta-analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation

Iris C Steenstraten  1 , Kerem Sebib Korkmaz  1 , Palak J Trivedi  2   3   4   5 , Akin Inderson  1 , Bart van Hoek  1 , Mar D M Rodriguez Girondo  6 , P W Jeroen Maljaars  1
Affiliations
Meta-Analysis

Systematic review with meta-analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation

Iris C Steenstraten et al. Aliment Pharmacol Ther. 2019 Mar.

Abstract

Background: After liver transplantation primary sclerosing cholangitis (PSC), the condition returns in the transplanted liver in a subset of patients (recurrent primary sclerosing cholangitis, rPSC).

Aim: To define risk factors for rPSC.

Methods: We searched Pubmed, Embase, Web of Science, and Cochrane library for articles published until March 2018. Studies addressing risk factors for developing rPSC were eligible for inclusion. A random effects meta-analysis was conducted using hazard ratios (HR) as effect measure. Study quality was evaluated with the Newcastle Ottawa scale. Statistical analysis was performed using Cochrane Review Manager.

Results: The electronic database search yielded 449 results. Twenty-one retrospective cohort studies met the inclusion criteria for the review; 14 were included in the meta-analysis. The final cohort included 2159 patients (age range 31-49 years, 68.8% male), of whom 17.7% developed rPSC. Colectomy before liver transplantation, HR 0.65 (95% CI: 0.42-0.99), cholangiocarcinoma before liver transplantation, HR 2.42 (95% CI: 1.20-4.86), inflammatory bowel disease, HR 1.73 (95% CI: 1.17-2.54), donor age, HR 1.24 (95% CI 1.0-1.45) per ten years, MELD score, HR 1.05 (95% CI: 1.02-1.08) per point and acute cellular rejection, HR of 1.94 (95% CI: 1.32-2.83) were associated with the risk of rPSC.

Conclusions: Multiple risk factors for rPSC were identified. Colectomy before liver transplantation reduced the risk of rPSC.

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Figures

Figure 1
Figure 1
Inclusion process
Figure 2
Figure 2
Potential risk factors for recurrent primary sclerosing cholangitis: (A) Colectomy before liver transplantation (B) IBD (Inflammatory bowel disease) presence (C) CCA (cholangiocarcinoma) before liver transplantation (D) Donor age per 10 y. (E) Any episode of ACR (acute cellular rejection) (F) Multiple episodes of ACR (G) MELD (Model of End Stage Liver Disease) score per point
See this image and copyright information in PMC

References

    1. Boonstra K, Beuers U, Ponsioen CY. Epidemiology of primary sclerosing cholangitis and primary biliary cirrhosis: a systematic review. J Hepatol. 2012;56:1181‐1188. - PubMed
    1. Maggs JR, Chapman RW. An update on primary sclerosing cholangitis. Curr Opin Gastroenterol. 2008;24:377‐383. - PubMed
    1. Egawa H, Ueda Y, Ichida T, et al. Risk factors for recurrence of primary sclerosing cholangitis after living donor liver transplantation in Japanese registry. Am J Transplant. 2011;11:518‐527. - PubMed
    1. Alexander J, Lord JD, Yeh MM, Cuevas C, Bakthavatsalam R, Kowdley KV. Risk factors for recurrence of primary sclerosing cholangitis after liver transplantation. Liver Transpl. 2008;14:245‐251. - PubMed
    1. Miki C, Harrison JD, Gunson BK, Buckels JA, McMaster P, Mayer AD. Inflammatory bowel disease in primary sclerosing cholangitis: an analysis of patients undergoing liver transplantation. Br J Surg. 1995;82:1114‐1117. - PubMed