Liver transplant in patients with primary sclerosing cholangitis: A retrospective cohort from Northeastern Brazil

Table 1 Clinical and socioepidemiological variables of patients with primary sclerosing cholangitis submitted to liver transplantation between 2012 and 2022

Variables	n	Total1	Females (n = 141)	Males (n = 191)	P value2
Age at LTx, yr	32	40 ± 14 (36)	43 ± 13 (39)	38 ± 14 (35)	0.347
Age at first symptom, yr	30	32 ± 14 (30)	35 ± 13 (36)	30 ± 14 (29)	0.498
Age at IBD diagnosis, yr	17	35 ± 14 (32)	37 ± 18 (42)	33 ± 12 (30)	0.370
Months between 1st symptom and 1st consultation	26	18 ± 37 (2)	16 ± 33 (3)	19 ± 39 (2)	0.616
Months between onset of symptoms and diagnosis	31	80 ± 235 (23)	148 ± 357 (56)	31 ± 41 (13)	0.155
Baseline clinical symptoms
Jaundice	32	29 (91%)	11 (85%)	18 (95%)	0.552
Pruritus	32	25 (74%)	6 (24%)	19 (76%)
Fever + shivering	32	14 (44%)	5 (38%)	9 (47%)	0.618
Weight loss	32	18 (56%)	9 (69%)	9 (47%)	0.221
Fatigue	32	13 (41%)	6 (46%)	7 (37%)	0.598
PSC classification
Classic PSC	31	30 (97%)	12 (92%)	18 (100%)	0.419
PSC + AIH	31	3 (9.7%)	3 (23%)	0 (0%)	0.064
Small-duct PSC	31	1 (3.2%)	0 (0%)	1 (5.6%)	> 0.999
Diagnostic testing
MRCP realized	32	23 (72%)	10 (77%)	13 (68%)	0.704
MRCP	32	20 (62%)	10 (77%)	10 (53%)	0.163
ERPC	32	12 (38%)	3 (23%)	9 (47%)	0.163
Biopsy	31	20 (65%)	7 (54%)	13 (72%)	0.449
Comorbidities
Diabetes	32	7 (22%)	2 (15%)	5 (26%)	0.671
Hypertension	32	6 (19%)	4 (31%)	2 (11%)	0.194
Dyslipidemia	32	4 (12%)	2 (15%)	2 (11%)	> 0.999
Obesity	32	1 (3.1%)	0 (0%)	1 (5.3%)	> 0.999
Smoking	32	4 (12%)	2 (15%)	2 (11%)	> 0.999
Drinking	32	6 (19%)	2 (15%)	4 (21%)	> 0.999
Others	31	8 (26%)	2 (17%)	6 (32%)	0.433
IBD	18				> 0.999
Ulcerative rectocolitis		15 (83%)	7 (88%)	8 (80%)
Crohn’s disease		3 (17%)	1 (12%)	2 (20%)
Ankylosing spondylitis	32	0 (0%)	0 (0%)	0 (0%)
Seronegative arthritis	32	0 (0%)	0 (0%)	0 (0%)
Gallbladder calculus	32	7 (22%)	3 (23%)	4 (21%)	> 0.999
Gallbladder polyps	31	0 (0%)	0 (0%)	0 (0%)
Neoplasia	31	4 (13%)	2 (15%)	2 (11%)	> 0.999
Dyslipidemia	32	4 (12%)	2 (15%)	2 (11%)	> 0.999
Obesity	32	1 (3.1%)	0 (0%)	1 (5.3%)	> 0.999
Smoking	32	4 (12%)	2 (15%)	2 (11%)	> 0.999
Drinking	32	6 (19%)	2 (15%)	4 (21%)	> 0.999
Other	31	8 (26%)	2 (17%)	6 (32%)	0.433
Treatment
Ursodeoxycholic acid	29	27 (93%)	11 (92%)	16 (94%)	0.665
Prednisone	27	14 (52%)	9 (75%)	5 (33%)	0.031
Endoscopic treatment	16	8 (50%)	1 (12%)	7 (88%)	0.010
Indication for LTx					> 0.999
Untreatable pruritus		4 (12%)	2 (15%)	2 (11%)
Decompensated cirrhosis		27 (84%)	11 (85%)	16 (84%)
Hepatocellular carcinoma		1 (3.1%)	0 (0%)	1 (5.3%)
Dominant stenosis	26	4 (15%)	1 (9.1%)	3 (20%)	0.614

¹Range; mean ± SD (median); n (%).

²Wilcoxon rank sum exact test; Wilcoxon rank sum test; Fisher’s exact test; Pearson’s χ² test.

AIH: Autoimmune hepatitis; ERCP: Endoscopic retrograde cholangiopancreatography; IBD: Inflammatory bowel disease; LTx: Liver transplantation; PSC: Primary sclerosing cholangitis; MRCP: Magnetic resonance cholangiopancreatography.

Table 2 Baseline and pretransplantation laboratory findings of patients with primary sclerosing cholangitis

Variables	n	Total1	Females (n = 141)	Males (n = 191)	P value2
ALP/RV1c	19	3.72 ± 3.02 (2.86)	2.23 ± 1.58 (1.89)	4.60 ± 3.37 (3.35)	0.045
GGT/RV1c	19	10 ± 9 (5)	5 ± 4 (4)	12 ± 9 (10)	0.210
AST/RV1c	23	5.86 ± 11.29 (3.00)	10.63 ± 18.86 (3.30)	3.31 ± 1.53 (2.86)	0.591
ALT/RV1c	23	3.28 ± 3.19 (2.46)	3.80 ± 5.18 (1.93)	3.01 ± 1.53 (2.75)	0.302
DB	24	7.4 ± 5.3 (5.9)	8.9 ± 5.2 (7.3)	6.8 ± 5.4 (5.9)	0.383
Antibody testing
ANA	20	3 (15%)	1 (17%)	2 (14%)	> 0.999
AASM	19	2 (11%)	1 (17%)	1 (7.7%)	> 0.999
AMA	19	0 (0%)	0 (0%)	0 (0%)
ANTI-SLA	11	0 (0%)	0 (0%)	0 (0%)
pANCA	12	4 (33%)	1 (33%)	3 (33%)	> 0.999
Pre-LTx lab results
ALT/RV	22	5.5 ± 8.8 (3.0)	6.2 ± 12.6 (2.1)	4.9 ± 4.1 (4.0)	0.138
AST/RV	23	16 ± 44 (5)	24 ± 66	9 ± 14 (5)	0.107
ALP/RV	22	2.79 ± 2.24 (1.84)	2.39 ± 2.37 (1.64)	3.06 ± 2.20 (2.54)	0.393
TB	22	15 ± 10 (11)	13 ± 10 (10)	17 ± 10 (12)	0.324
INR	27	2.08 ± 2.34 (1.51)	1.40 ± 0.32 (1.37)	2.54 ± 2.98 (1.71)	0.025
Creatinine	28	0.89 ± 0.80 (0.75)	0.94 ± 1.19 (0.52)	0.86 ± 0.34 (0.83)	0.143
MELD	27	22.4 ± 6.5 (22.0)	19.9 ± 8.1 (19.0)	24.1 ± 4.7 (23.5)	0.011

¹Range; mean ± SD (median); n (%).

²Wilcoxon rank sum exact test; Wilcoxon rank sum test; Fisher’s exact test; Pearson’s chi-squared test.

AASM: Anti-smooth muscle antibodies; ALP: Alkaline phosphatase; ALT: Alanine transaminase; AMA: Anti-mitochondrial antibody; ANA: Anti-nuclear antibodies; Anti-SLA: Anti-soluble liver antigen; AST: Aspartate transferase; DB: Direct bilirubin; GGT: γ-Glutamyl transferase; INR: International normalized ratio; MELD: Model for end-stage liver disease; pANCA: Perinuclear anti-neutrophil cytoplasmic antibody; RV: Reference value; TB: Total bilirubin; LTx: Liver transplantation.

Table 3 Clinical variables of patients with primary sclerosing cholangitis according to the presence/absence of inflammatory bowel disease

	Total1	IBD1 yes	IBD1 no	P value2
Total	26	18 (69.2%)	9 (30.8%)	0.440
Sex				0.692
Male	16 (59%)	6 (67%)	10 (56%)
Female	11 (41%)	3 (33%)	8 (44%)
Age	40 ± 13 (36)	38 ± 15 (34)	35 ± 14 (32)
Ulcerative colitis	15 (83%)
Crohn’s disease	3 (17%)
AST/RV1c	6.1 ± 12.1 (2.9)	12.2 ± 19.8 (3.7)	2.8 ± 1.6 (2.6)	0.014
DM	5 (19%)	4 (44%)	1 (5.6%)	0.030
Esophageal varices				0.027
No	9 (36%)	0 (0%)	9 (50%)
Yes	16 (64%)	7 (100%)	9 (50%)
MELD	21.3 ± 5.5 (22.0)	24.6 ± 5.4 (23.0)	19.3 ± 4.7 (19.0)	0.033
Anastomosis
Roux-en-Y	8 (31%)	0 (0%)	8 (47%)	0.023
End-to-end	18 (69%)	9 (100%)	9 (53%)

¹Range; mean ± SD (median); n (%).

²Wilcoxon rank sum exact test; Wilcoxon rank sum test; Fisher’s exact test; Pearson’s χ² test.

AST: Aspartate transferase; DM: Diabetes mellitus; MELD: Model for end-stage liver disease; RV: reference value.