未经证实:原发性硬化性胆管炎(PSC)的肝移植(LT)在高达25%的接受者中并发PSC(rPSC)复发。复发已被证明对移植物和患者的存活都是有害的。对于PSC和rPSC,医学治疗是不可用的。为了预测并理想地防止rPSC,因此,必须找到可能被改变的rPSC的危险因素.因此,我们旨在在一项大型国际多中心研究中确定rPSC的这些因素,该研究包括PSC流行国家的6个中心.
未经批准:在这个国际多中心,回顾性队列研究,纳入531例接受PSC移植的患者。在25%的病例中(n=131),rPSC是在LT后6.72(3.29-10.11)年的中位随访后诊断的。
UNASSIGNED:在具有时间依赖协变量的多变量竞争风险模型中,我们发现,代表炎症状态增加的因素会增加rPSC的风险.LT前复发性胆管炎作为LT的指征(危险比[HR]3.6,95%CI2.5-5.2),LT后炎症性肠病的活动性增加(HR1.7,95%CI1.08-2.75),和多个急性细胞排斥反应(HR:非线性)与rPSC风险增加显著且独立相关。与以前的研究结果相反,未发现移植前结肠切除术对rPSC的发展具有独立保护作用.
UNASSIGNED:LT前后炎症状态的增加可能在rPSC的发展中起因果和可改变的作用。移植前结肠切除术本身并没有降低rPSC的风险。复发性胆管炎作为LT的指征与rPSC风险增加相关。
未经评估:PSC的复发(rPSC)对肝移植(LT)后的存活率产生负面影响。可改变的危险因素可以指导rPSC的临床管理和预防。我们证明,LT前后炎症状态的增加会增加rPSC的发生率。由于这些是可改变的因素,它们可以作为未来研究和治疗的目标。我们还为正在进行的关于rPSC预防性结肠切除术的辩论增加了进一步的证据,报告说,在我们的多中心研究中,我们未能发现结肠切除术与rPSC风险之间存在独立关联.
UNASSIGNED: Liver transplantation (LT) for primary sclerosing cholangitis (PSC) is complicated by recurrence of PSC (rPSC) in up to 25% of recipients. Recurrence has been shown to be detrimental for both graft and patient survival. For both PSC and rPSC, a medical cure is not available. To predict and ideally to prevent rPSC, it is imperative to find risk factors for rPSC that can be potentially modified. Therefore, we aimed to identify such factors for rPSC in a large international multicentre study including 6 centres in PSC-prevalent countries.
UNASSIGNED: In this international multicentre, retrospective cohort study, 531 patients who underwent transplantation for PSC were included. In 25% of cases (n = 131), rPSC was diagnosed after a median follow-up of 6.72 (3.29-10.11) years post-LT.
UNASSIGNED: In the multivariable competing risk model with time-dependent covariates, we found that factors representing an increased inflammatory state increase the risk for rPSC. Recurrent cholangitis before LT as indication for LT (hazard ratio [HR] 3.6, 95% CI 2.5-5.2), increased activity of inflammatory bowel disease after LT (HR 1.7, 95% CI 1.08-2.75), and multiple acute cellular rejections (HR: non-linear) were significantly and independently associated with an increased risk of rPSC. In contrast to the findings of previous studies, pretransplant colectomy was not found to be independently protective against the development of rPSC.
UNASSIGNED: An increased inflammatory state before and after LT may play a causal and modifiable role in the development of rPSC. Pretransplant colectomy did not reduce the risk of rPSC per se. Recurrent cholangitis as indication for LT was associated with an increased risk of rPSC.
UNASSIGNED: Recurrence of PSC (rPSC) negatively affects survival after liver transplant (LT). Modifiable risk factors could guide clinical management and prevention of rPSC. We demonstrate that an increased inflammatory state both before and after LT increases the incidence of rPSC. As these are modifiable factors, they could serve as targets for future studies and therapies. We also added further evidence to the ongoing debate regarding preventive colectomy for rPSC by reporting that in our multicenter study, we could not find an independent association between colectomy and risk of rPSC.