Long term (15 year) complications & outcomes after liver transplantation for primary sclerosing cholangitis: Impact of donor and recipient factors.

Background: With longer survival of patients with PSC undergoing liver transplantation (LT), the frequency and risk factors associated with vascular and biliary complications in the allograft and the impact on long-term outcomes are poorly understood.

Aim: To assess frequency and risk factors for long term outcomes in patients post-LT for PSC.

Methods: All LT recipients for advanced stage PSC for non-cholangiocarcinoma indication from 1984-2012, with follow-up through March 2022 (>10+year followup) were idenitfied. 1-, 5-, and 10-yr cumulative risks of complications were estimated using the Aalen-Johansen method, where death was considered a competing risk.

Results: Two hundred ninety-three patients (mean age, 47.3±12 y), formed our study cohort. One hundred and thirty-four patients received LT before 1995 and the 159 were transplanted after 1995. Over a median (interquartile range) follow-up of 15.0 (10.3-22.1) years, LT was complicated by hepatic artery thrombosis (N=30), portal vein stenosis/thrombosis (N=48), biliary leak (N=47), biliary strictures (N=87), rPSC (N=107), and graft failure (N=70). The 1-, 5-, 10-, and 15-year cumulative incidence of rPSC was 1.0%, 8.0%, 23.5%, and 34.3% respectively. Type of donor and older donor age were associated with increased risk of biliary strictures. Donor age >60 years was associated with increased risk of rPSC.

Conclusion: Long-term patient and graft-survival have not changed significantly for patients transplanted for PSC. Controlling transplant related factors such as donor age, prompt identification of vascular and biliary complications early and long-term rigorous followup is recommended to continue to improve on these outcomes.