BACKGROUND AIMS Primary sclerosing cholangitis (PSC) may reoccur following liver transplantation (LT) and the diagnosis established once imaging studies demonstrate the diagnostic cholangiographic appearance. To evaluate whether the development of recurrent PSC (rPSC) is associated with cholestasis soon after LT, we studied whether changes in hepatic biochemistry within the first 12 months were linked with the development of rPSC and graft loss. METHODS We conducted a retrospective cohort analysis of 158 transplant recipients with PSC in Canada, and 549 PSC transplant recipients from the United Kingdom. We evaluated serum liver tests within 12 months after LT and the subsequent development of a cholangiographic diagnosis of rPSC as a time-dependent covariate using Cox regression. Severe cholestasis was defined as either alkaline phosphatase> 3xupper limit of normal or total bilirubin> 100 μmol/L. RESULTS Patients who developed rPSC were more likely to have severe cholestasis versus those without at 3 months (20.5% vs 8.2%, p=0.011), at 6 months (17.9% vs. 10.0%, p=0.026) and 12 months (15.4% vs. 7.8%, p=0.051) in the Canadian cohort and at 12 months in the UK cohort (27.9% vs. 12.6%, p<0.0001). By multivariable analysis, development of severe cholestasis in the Canadian cohort at 3 months (HR=2.41, p=0.046) and in the UK cohort at 12 months (HR=3.141, p<0.0001) were both associated with rPSC. Severe cholestasis at 3 months in the Canadian cohort was predictive of graft loss (HR=3.88, p=0.0001). CONCLUSIONS The development of cholestasis within 3 to 12 months following LT was predictive of rPSC and graft loss.

中文翻译：

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严重胆汁淤积预示着肝移植后复发性原发性硬化性胆管炎。


背景 目的 原发性硬化性胆管炎 (PSC) 可能在肝移植 (LT) 后复发，并且一旦影像学研究证实诊断性胆管造影表现即可确定诊断。为了评估复发性 PSC (rPSC) 的发生是否与 LT 后不久的胆汁淤积相关，我们研究了前 12 个月内肝脏生化的变化是否与 rPSC 的发生和移植物丢失有关。方法 我们对加拿大 158 名 PSC 移植接受者和英国 549 名 PSC 移植接受者进行了回顾性队列分析。我们评估了 LT 后 12 个月内的血清肝脏测试，以及随后使用 Cox 回归将 rPSC 胆管造影诊断作为时间依赖性协变量的发展。严重胆汁淤积定义为碱性磷酸酶>正常上限的3倍或总胆红素>100μmol/L。结果 发生 rPSC 的患者与未发生 rPSC 的患者相比，在 3 个月时（20.5% vs 8.2%，p=0.011）、6 个月时（17.9% vs. 10.0%，p=0.026）和 12 个月时（15.4%）更有可能出现严重胆汁淤积。 % vs. 7.8%，p=0.051）在加拿大队列中和在英国队列中 12 个月时（27.9% vs. 12.6%，p<0.0001）。通过多变量分析，加拿大队列在 3 个月时（HR=2.41，p=0.046）和英国队列在 12 个月时出现严重胆汁淤积（HR=3.141，p<0.0001）均与 rPSC 相关。加拿大队列中 3 个月时的严重胆汁淤积预示着移植物丢失（HR=3.88，p=0.0001）。结论 LT 后 3 至 12 个月内出现胆汁淤积可预测 rPSC 和移植物丢失。