A second liver transplantation results in transplantation and patient outcomes in people with primary sclerosing cholangitis (PSC) equal or greater than those observed in other liver diseases, studies show It's there.
The survival rates of the transplanted liver (graft) and patients were significantly better than those of PSC patients. When the second liver transplant or re-implantation was due to recurrent PSC, graft survival was comparable to that seen in non-PSC patients in general, but patient survival was significantly better.
“Our findings strongly support the practice of providing replanting in PSC patients, even patients with recurrent disease following implantation,” the researchers wrote.
the study, “Liver transplantation results in patients with primary sclerosing cholangitis.has been published Liver International.
PSCs are the chronic autoimmune form of cholangitis, a condition characterized by inflammation and scarring of the bile duct, transporting digestive fluid bile from the liver to the intestine. As a result, bile accumulates in the liver, causing damage, and ultimately leads to permanent scars (cirrhosis) and liver failure. There is no approved treatment for slowing or stopping liver damage caused by PSC.
PSC-only treatment
Liver transplantation is the only treatment for PSC. The condition is a major indication of procedures in Scandinavian countries, and “trends are increasing in North America and Europe,” the researchers write.
However, in up to 30% of cases, PSCs recur after liver transplantation. A second liver transplant is often indicated due to the lack of treatment to prevent recurrent PSCs. Still, little is known about the outcome of liver transplantation in PSC patients.
A team led by scientists at the University of Oslo Hospital analyzed data from the Nordic Liver Transplant Registry, including data from all patients undergoing liver transplants in Norway, Sweden, Denmark, Finland, Iceland and Estonia.
Of the 8,486 adult patients who received liver transplants from 1982 to 2022, 10.2% received their second transplant, of which 185 had PSCs. As a comparative group, the researchers looked at data from 208 people undergoing re-grafting due to non-acute liver failure, non-viral, non-cancerous, and non-urgent liver conditions other than PSC.
Comparing data from both groups, teams found that graft survival rates after re-implantation were greater than those in 1 year (85% vs 66%), 5 years (73% vs 54%) and 10 years comparison groups. We found that it was significantly superior among PSC patients. (61% vs. 44%), 2015 (41% vs. 33%), 2020 (36% vs. 17%).
Important predictors of graft survival in PSCs include patient age, liver donor age, dialysis at the time of implantation, PSC as the first indication of implantation, and schizophrenia liver transplantation.
Dialysis is a procedure that replicates the function of the kidneys when the organs are not functioning properly. Fractionated liver transplantation involves splitting a single liver transplant into two partial grafts that have been implanted in two different patients.
Patient survival was significantly better in the PSC group, with dialysis, fractionated implantation, and PSC as the first transplant signs as important predictors. However, PSC patients had higher rates of multiple retransplants than the comparison group (19% vs. 10%).
PSC patients had improved graft and patient survival when compared to people with certain non-PSC liver diseases, such as alcohol-related liver disease, primary bile duct cholangitis, and autoimmune hepatitis.
Similar results were found when comparing PSC patients with PSC patients who were originally transplanted due to signs of virus or cancer that were excluded from the comparison group.
Liver transplant results
The researchers then selected patients who received a re-implantation (compared to PSC) at least 5 years after the first implantation to assess the effects of recurrent PSCs (RPSCs) on the outcome of the second implantation.
Patients with recurrent PSC survived significantly longer than the comparison group, as predicted by a measure of chronic liver disease severity, as predicted by donor age and model scores for end-stage liver disease assessment. However, RPSCs themselves did not appear to predict patient survival.
Additionally, graft survival rates improved in comparison groups over 1 year (87% vs 69%), 5 year (79% vs 60%), and 10 year (59% vs 56%) among patients with RPSC. There was a tendency to do so. . Here, pre-transplant dialysis was the only important predictor of graft survival.
Finally, the team evaluated the futility of liver transplants in PSC and RPSC patients, as indicated by 5-year mortality rates with 90-day and 5-year mortality rates above 50%.
Compared with the respective comparison groups, mortality at 90 days tended to be lower in PSC patients (5.4% vs. 10.1%) and RPSC patients (5.9% vs. 9.3%), whereas 5-year mortality at PSC was significantly lower (32.6% vs. 51.7%) and the RPSC group (27.6% vs. 50%).
“Our data suggests that re-ltx [liver retransplantation] PSCs have good performance in terms of graft and patient survival. [indications] It does not represent wasteful use of liver grafts,” the scientist wrote. “While we are seeking new effective treatment strategies for PSC and RPSC, RE-LTX of first-time PSC transplanted patients transplanted into PSCs when necessary, encouraged in national and international liver transplant programs. You need to do that.”
