183 RECURRENCE OF PRIMARY SCLEROSING CHOLANGITIS AFTER LIVER TRANSPLANTATION

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Background: With longer survival of patients with PSC undergoing LT, recurrence of PSC (rPSC) in the allograft is increasingly being recognized. The risk factors associated with rPSC and its impact on long-term patient-related outcomes are poorly understood. Aim: To examine the cumulative incidence, risk factors and longterm outcomes from rPSC. Methods: We identified all patients who underwent LT for advanced stage PSC for non-cholangiocarcinoma indication at Mayo Clinic, Rochester from 1998–2008, with follow-up through 2012. rPSC was defined based on Mayo Clinic diagnostic criteria. All potential risk factors for rPSC were analyzed using multivariate Cox proportional hazard analysis. Survival and time-to-recurrence curves were calculated using the Kaplan–Meier method. Results: 101 patients underwent LT for end-stage liver disease due to PSC followed for a median (IQR) 8.4 (5.5–10.7) yrs were included in the analysis (age at time of LT 48±12.8 yrs; 62 males). rPSC was identified in 25 patients, with 1-, 5-, 10and 15-yr risk of rPSC of 0%, 10.9%, 21.8% and 24.7%, respectively. rPSC was associated with a worse allograft survival and risk of re-transplantation (rPSC v. no rPSC: 10-yr graft survival = 64% v. 92%, p = 0.006; 10-yr re-transplantation-free survival = 84% v. 96%, p = 0.039), though overall patient survival and cancer-free survival was not different. On multivariate Cox proportional hazard analysis, use of MMF was associated with a 3.2 fold higher risk of rPSC, whereas prolonged prednisone use (>6 months) was associated with 75% lower risk of rPSC (Table). It was unrelated to recipient or donor age, gender, smoking status, CMV mismatch/infection, acute or chronic rejection or pre-LT IBD. Conclusion: rPSC is common after LT for PSC, and is associated with worse graft survival. The risk is modified by immunosuppressive agents used, but unrelated to pre-transplant colectomy.