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. 2025 Jul 24.
doi: 10.14309/ajg.0000000000003659. Online ahead of print.

Recurrence of Primary Sclerosing Cholangitis After Liver Transplantation: A French National Cohort Study Including 571 Patients

Florian Veyre  1   2 , Eleonora De Martin  3 , Domitille Erard  1 , Claire Francoz  4 , Laure Elkrief  5 , Camille Besch  6 , Olivier Boillot  7 , Filomena Conti  8 , Sébastien Dharancy  9 , Christophe Duvoux  10 , Jean Gugenheim  11 , Jean Hardwigsen  12 , Marie-Noëlle Hilleret  13 , Vincent Leroy  13 , Isabelle Ollivier-Hourmand  14 , Marilyne Gratien  15 , Pauline Houssel-Debry  16 , Nassim Kamar  17 , Olivier Roux  4 , Jean-Baptiste Hiriart  18 , Marie Irles-Depe  18 , Sophie Pellegrin  4 , François Durand  4 , Georges-Philippe Pageaux  19 , Stéphanie Faure  19 , Audrey Coilly  3 , Sylvie Radenne  1 , Faouzi Saliba  3 , Didier Samuel  3 , Claire Vanlemmens  20 , Marianne Latournerie  21 , Karim Boudjema  22 , Ephrem Salamé  23 , Christophe Corpechot  24 , Olivier Chazouillères  24 , Jérôme Dumortier  2   7
Affiliations

Recurrence of Primary Sclerosing Cholangitis After Liver Transplantation: A French National Cohort Study Including 571 Patients

Florian Veyre et al. Am J Gastroenterol. .

Abstract

Introduction: Primary sclerosing cholangitis (PSC) may recur after liver transplantation (LT). We aimed to evaluate the incidence of recurrent PSC (rPSC), its characteristics, and risk factors, in a large cohort with long-term follow-up.

Methods: We conducted a nationwide multicenter retrospective study in France, including all adult patients transplanted for PSC from March 1985 to March 2019. Clinical, biological, and histological data were collected. Risk factors for rPSC were identified using a multivariate Cox-regression model.

Results: Five hundred seventy-one patients were included (389 males, 68.1%) with a median age at LT of 42.0 (interquartile range [IQR] 32.0-52.8). Median follow-up after LT was 7.4 years (IQR 3.6-12.6). Overall, rPSC occurred in 25.9% of patients; actuarial risk of developing rPSC at 5, 15, and 25 years was 15.6%, 37.9%, and 52.6%, respectively. The median time to rPSC was 4.9 years (IQR 2.3-8.9). The factors independently associated with rPSC were the presence of IBD (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.24-3.14), maintenance treatment with corticosteroids (HR 1.76, 95% CI 1.17-2.66), and younger age at LT (HR 1.02 per 1-year increase, 95% CI 1.01-1.03). Type of biliary anastomosis or preventive treatment with ursodeoxycholic acid had no impact on the incidence of rPSC.

Discussion: Our results from a large cohort with long-term follow-up strongly confirm that rPSC after LT is frequent. The only modifiable factor associated with rPSC was maintenance treatment with corticosteroids, which could therefore be discontinued in the absence of a specific extrahepatic indication.

Keywords: liver transplantation; primary sclerosing cholangitis; recurrence; risk factors.

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