Summary
Background
After liver transplantation primary sclerosing cholangitis (PSC), the condition returns in the transplanted liver in a subset of patients (recurrent primary sclerosing cholangitis, rPSC).
Aim
To define risk factors for rPSC.
Methods
We searched Pubmed, Embase, Web of Science, and Cochrane library for articles published until March 2018. Studies addressing risk factors for developing rPSC were eligible for inclusion. A random effects meta‐analysis was conducted using hazard ratios (HR) as effect measure. Study quality was evaluated with the Newcastle Ottawa scale. Statistical analysis was performed using Cochrane Review Manager.
Results
The electronic database search yielded 449 results. Twenty‐one retrospective cohort studies met the inclusion criteria for the review; 14 were included in the meta‐analysis. The final cohort included 2159 patients (age range 31‐49 years, 68.8% male), of whom 17.7% developed rPSC. Colectomy before liver transplantation, HR 0.65 (95% CI: 0.42‐0.99), cholangiocarcinoma before liver transplantation, HR 2.42 (95% CI: 1.20‐4.86), inflammatory bowel disease, HR 1.73 (95% CI: 1.17‐2.54), donor age, HR 1.24 (95% CI 1.0‐1.45) per ten years, MELD score, HR 1.05 (95% CI: 1.02‐1.08) per point and acute cellular rejection, HR of 1.94 (95% CI: 1.32‐2.83) were associated with the risk of rPSC.
Conclusions
Multiple risk factors for rPSC were identified. Colectomy before liver transplantation reduced the risk of rPSC.
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