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P703 De-novo inflammatory bowel disease is a significant risk factor for primary sclerosing cholangitis recurrence after liver transplantation

L. Bajer*1, E. Sticova2, P. Macinga1, R. Janousek3, P. Trunecka4, J. Spicak1, P. Drastich1

1Institute for Clinical and Experimental Medicine, Hepatogastroenterology, Prague, Czech Republic, 2Institute for Clinical and Experimental Medicine, Pathology, Prague, Czech Republic, 3Institute for Clinical and Experimental Medicine, Radiology, Prague, Czech Republic, 4Institute for Clinical and Experimental Medicine, Transplantcentre, Prague, Czech Republic

Background

Primary sclerosing cholangitis (PSC) is a chronic liver disorder of unknown aetiology, characterised by inflammation, fibrosis, and stenoses. The disease may progress to cirrhosis and eventually to liver failure and death. For those who develop end-stage liver disease, orthotopic liver transplantation (OLT) remains the only effective treatment currently available. However, recurrent form of PSC (rPSC) often appears in patients after OLT and may eventually lead to graft loss and liver re-transplantation (re-OLT). PSC is often accompanied by inflammatory bowel disease (IBD), which can appear both before and after OLT. IBD in patients with PSC is often referred as ‘PSC-IBD’ and is considered to be a distinct phenotype of IBD.

Methods

In total,115 orthotopic liver transplantations for PSC were performed at the Institute for Clinical and Experimental Medicine, Prague, Czech Republic, between July 1994 and May 2015. The diagnosis of rPSC was based on histology and cholangiographic findings. We retrospectively analysed medical records of all PSC patients from our computed database. Only patients with a proper record of pre-OLT (≤ 12 months) colonoscopy, and those monitored for a time period of ≥ 60 months post-OLT were included. Input data were analysed using JMP statistical software. Student’s t-test, Fisher’s exact test, and nominal logistic regression were used to assess the data. A p-value < 0.05 was considered as statistically significant.

Results

After applying inclusion/exclusion criteria, we analysed a cohort of 47 patients. Amongst them, 31 were male and 16 female, with median age of 36 (range 15–68) and median follow-up 122 months (range 60–249) after OLT. In 21/47 (44.7%) patients, rPSC was diagnosed during the follow-up. Two patients underwent re-OLT (after 103 and 116 months, respectively, both for rPSC). According to performed univariate analysis, presence of de-novo IBD (p = 0.0002; OR 27.50, 95% CI 3.13–241.94) and OLT for overlap with autoimmune hepatitis (PSC/AIH) (p = 0.0133) were significantly associated with rPSC. Presence of HLA-DRB1*04 in the recipient was identified as protective factor for rPSC (p = 0.0287). In case of de–novo IBD, statistical significance was further confirmed by nominal logistic regression analysis (p = 0.0094; OR 22.00, 95% CI 2.04–591.60).

Conclusion

Recurrent PSC is an important clinical entity with high prevalence in patients after OLT. De-novo IBD is a novel significant risk factor associated with rPSC.