PSC-specific prognostic scores associated with graft loss and overall mortality in recurrent PSC after liver transplantation

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-06-01 DOI:10.1016/j.dld.2025.02.001

Ellina Lytvyak , Dennis Wang , Devika Shreekumar , Maryam Ebadi , Yousef Alrifae , Andrew Mason , Aldo J. Montano-Loza

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引用次数: 0

Abstract

Background

Primary sclerosing cholangitis (PSC) is a progressive liver disease with no treatment apart from liver transplantation (LT). After LT, patients can develop recurrent PSC (rPSC). The United-Kingdom (UK-PSC) and Amsterdam-Oxford (AOPSC) scores are used as prognostic models for PSC outcomes.

Aim

We aimed to assess these scores as predictive tools for graft loss and overall mortality in rPSC.

Methods

We evaluated 67 people who developed rPSC. Using Cox regression models, we quantified associations between UK-PSC and AOPSC scores and graft loss and overall mortality. Cut-offs were established using receiver operator characteristic analysis and the highest Youden index.

Results

Fifty-one individuals (76.1%) were males, with a mean age of 40±15 years. Both UK-PSC and AOPSC scores were independently associated with graft loss (hazard ratio [HR] 2.43 (p < 0.001) and HR 3.45 (p < 0.001), respectively), but only the UK-PSC score was independently associated with overall mortality (HR 2.63 (p = 0.009)). Individuals with UK-PSC ≥-4.2 (6.1 ± 0.8 vs. 14.7 ± 1.0 years; p = 0.001) and AOPSC ≥2.4 (5.4 ± 1.3 vs. 12.0 ± 1.1 years; p < 0.001) had shorter graft survival.

Conclusion

UK-PSC score at rPSC predicts both graft loss and overall mortality, while AOPSC scores using either age at rPSC or at diagnosis along with severe cholestasis predict graft loss in people with rPSC. These easy-to-administer tools can be utilized in clinical practice to identify high-risk rPSC patients and guide decisions about monitoring/interventions.

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PSC特异性预后评分与肝移植后复发PSC的移植物损失和总死亡率相关。

背景：原发性硬化性胆管炎（PSC）是一种进行性肝病，除肝移植（LT）外无其他治疗方法。肝移植后，患者可发生复发性PSC （rPSC）。英国（UK-PSC）和阿姆斯特丹-牛津（AOPSC）评分被用作PSC结果的预测模型。目的：我们的目的是评估这些评分作为rPSC移植损失和总死亡率的预测工具。方法：对67例rPSC患者进行评估。使用Cox回归模型，我们量化了UK-PSC和AOPSC评分与移植物损失和总死亡率之间的关系。利用接收算子特征分析和最高约登指数确定截止点。结果：男性51例（76.1%），平均年龄40±15岁。UK-PSC和AOPSC评分均与移植物损失独立相关（风险比分别为2.43 （p < 0.001）和3.45 (p < 0.001)），但只有UK-PSC评分与总死亡率独立相关（风险比为2.63 (p = 0.009)）。UK-PSC≥-4.2的个体（6.1±0.8∶14.7±1.0年）；p = 0.001), AOPSC≥2.4(5.4±1.3∶12.0±1.1年；P < 0.001)的移植物存活时间较短。结论：rPSC患者的UK-PSC评分可以预测移植物损失和总死亡率，而AOPSC评分使用rPSC时的年龄或诊断时的严重胆汁淤积来预测rPSC患者的移植物损失。这些易于管理的工具可以在临床实践中用于识别高危rPSC患者并指导有关监测/干预的决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.