Recurrence of primary sclerosing cholangitis in pediatric liver transplant recipients

There is little detailed clinical information on recurrent primary sclerosing cholangitis (rPSC) after liver transplantation in children. Our purpose was to describe the characteristics of children who had experienced rPSC after liver transplantation so that we could identify potential risk factors...

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Published inLiver transplantation Vol. 20; no. 6; pp. 679 - 686
Main Authors Venkat, Veena L., Ranganathan, Sarangarajan, Mazariegos, George V., Sun, Qing, Sindhi, Rakesh
Format Journal Article
LanguageEnglish
Published United States Wiley Subscription Services, Inc 01.06.2014
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Summary:There is little detailed clinical information on recurrent primary sclerosing cholangitis (rPSC) after liver transplantation in children. Our purpose was to describe the characteristics of children who had experienced rPSC after liver transplantation so that we could identify potential risk factors for recurrence. Clinical information for pediatric patients undergoing transplantation for primary sclerosing cholangitis (PSC) was retrospectively reviewed, and variables related to the pretransplant diagnosis of PSC and posttransplant variables were ed. The studied variables included the following: cytomegalovirus/Epstein‐Barr virus status, early/late rejection, induction regimen, immunosuppression in the first year, steroid‐resistant rejection, diagnosis of inflammatory bowel disease, and human leukocyte antigen markers commonly associated with PSC. A diagnosis of rPSC was made on the basis of radiographic features, histology, or both. Twelve patients underwent liver transplantation for PSC between 1993 and 2012. Patients received tacrolimus for maintenance immunosuppression after induction with steroids (n = 6) or thymoglobulin (n = 6). Three patients were diagnosed with rPSC 44, 60, and 62 months after transplantation. A fourth patient underwent retransplantation for graft failure with features of both hepatic artery stenosis and rPSC. This patient had distinct histological features of rPSC in the second graft. Three of the 4 patients were 7 years old or younger at the diagnosis of PSC. The patient and graft survival rates were similar for the steroid and thymoglobulin groups. All 4 children with rPSC received steroid‐free thymoglobulin induction. In conclusion, our observation of an association between thymoglobulin, and age less than 10 years at the diagnosis of PSC, and rPSC adds to the existing suggestion of a link between the immune environment and the pathogenesis of rPSC. Defining the natural history of rPSC and searching for the etiology and risk factors of rPSC are important for the long‐term outcomes of pediatric patients. Liver Transpl 20:679‐686, 2014. © 2014 AASLD.
Bibliography:The authors have no conflicts of interest to declare.
This work was supported in part by the Health Resources and Services Administration (contract 234‐2005‐37011C). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
There were no grants or financial support associated with this study.
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ISSN:1527-6465
1527-6473
DOI:10.1002/lt.23868