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. 2025 Jan;45(1):e16214.
doi: 10.1111/liv.16214.

Outcome of Liver Retransplantation in Patients With Primary Sclerosing Cholangitis

Antonio Molinaro  1   2   3 , Lise Katrine Engesæter  2   3   4   5 , Carl Jorns  6 , Arno Nordin  7 , Allan Rasmussen  8 , Pål-Dag Line  4   9 , Virge Pall  10 , Bo-Göran Ericzon  6 , William Bennet  11 , Johannes R Hov  2   3   4   5 , Espen Melum  2   3   4   5   12
Affiliations

Outcome of Liver Retransplantation in Patients With Primary Sclerosing Cholangitis

Antonio Molinaro et al. Liver Int. 2025 Jan.

Abstract

Background and aims: Primary sclerosing cholangitis (PSC) is among the most common indications for liver transplantation in the Nordic countries and with an increasing trend in Europe and North America. Due to post-transplant complications and high prevalence of disease recurrence this group is at risk of requiring retransplantation (re-LTX). Results from re-LTX for PSC are not extensively studied and there is a lack of knowledge regarding prognosis after re-LTX in this population.

Methods: Graft and patient survival after re-LTX for patients with PSC and a comparable comparison group from the Nordic liver transplant registry were analysed. One-hundred and eighty-five patients with PSC and 208 patients in the comparison group were included.

Results: The graft and patient survival were better for patients with PSC compared to the comparison group (p < 0.001). Re-LTX for recurrence of PSC (rPSC) compared to other aetiologies had similar and better outcomes for graft and patient survival (p = 0.093 and p = 0.023, respectively). Moreover, re-LTX for rPSC compared to the comparison group had a lower 30-day and 5-year mortality (p < 0.001 and p = 0.041, respectively).

Conclusion: Outcomes after retransplantation for PSC were similar or better compared to the comparison group. Retransplantation represents a treatment option with the potential for excellent outcomes in patients with PSC and should be considered in transplanted PSC patients with graft failure.

Keywords: liver transplantation; primary sclerosing cholangitis; retransplantation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Selection criteria for study population for patients with primary sclerosing cholangitis (PSC) and the comparison group undergoing retransplantation (re‐LTX). Patients under 18 years of age, patients with positive serology for hepatitis B virus (HBV) or hepatitis C virus (HCV), patients with urgent liver transplantation (LTX) or with liver transplant due to acute liver failure (ALF) were excluded from the analysis. Figure was made with Bio‐Render.
FIGURE 2
FIGURE 2
Kaplan–Meier plot for graft survival in years after retransplantation for patients in the PSC and comparison group. p value was calculated with log‐rank test. The numbers shown below the survival graphs indicate the number of patients contributing to the analyses at that specific time point and in parenthesis the survival rate for patients with PSC and the comparison groups 1, 5, 10, 15 and 20 years after retransplantation. PSC, primary sclerosing cholangitis.
FIGURE 3
FIGURE 3
Kaplan–Meier plot for graft survival in years after retransplantation in a subset of patients with recurrence of PSC after transplantation (rPSC) and in an appropriate comparison group. rPSC defined as retransplantation performed > 5 years after first liver transplant in PSC. p‐value was calculated with log‐rank test. The numbers shown below the survival graphs indicate the number of patients contributing to the analyses at that specific time point and in parenthesis the survival rate for patients with PSC and the comparison groups 1, 5, 10, 15 and 20 years after retransplantation. PSC, primary sclerosing cholangitis.
FIGURE 4
FIGURE 4
Retransplant for PSC is not futile. Percentage of patients dead at 90 days (A) or after 5 years (B) from retransplantation in PSC and comparison group. Percentage of patients dead at 90 days (C) or after 5 years (D) from retransplantation in recurrence of PSC after transplantation (rPSC) and appropriate comparison group. p value were calculated using Fisher exact test. PSC, primary sclerosing cholangitis; rPSC, defined as retransplantation performed > 5 years after first liver transplant in PSC.
See this image and copyright information in PMC

References

    1. Karlsen T. H., Folseraas T., Thorburn D., and Vesterhus M., “Primary Sclerosing Cholangitis—A Comprehensive Review,” Journal of Hepatology 67, no. 6 (2017): 1298–1323. - PubMed
    1. Villard C., Jorns C., and Bergquist A., “Treatment of Cholangiocarcinoma in Patients with Primary Sclerosing Cholangitis: A Comprehensive Review,” eGastroenterology 2, no. 1 (2024): e100045.
    1. Fosby B., Melum E., Bjoro K., et al., “Liver Transplantation in the Nordic Countries—An Intention to Treat and Post‐Transplant Analysis From the Nordic Liver Transplant Registry 1982‐2013,” Scandinavian Journal of Gastroenterology 50, no. 6 (2015): 797–808. - PMC - PubMed
    1. Murillo Perez C. F., Ivanics T., Claasen M. P. A. W., et al., “Trends in Liver Transplantation for Autoimmune Liver Diseases: A Canadian Study,” Canadian Journal of Surgery 65, no. 5 (2022): E665–E674. - PMC - PubMed
    1. Berenguer M., Di Maira T., Baumann U., et al., “Characteristics, Trends, and Outcomes of Liver Transplantation for Primary Sclerosing Cholangitis in Female Versus Male Patients: An Analysis From the European Liver Transplant Registry,” Transplantation 105, no. 10 (2021): 2255–2262. - PubMed