肝移植后原发性硬化性胆管炎和新胆管癌的复发：巴西胆汁淤积症联合会的研究结果

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-10-22 DOI:10.1111/ctr.70002

Paulo Lisboa Bittencourt, Mateus Jorge Nardelli, Luísa Leite Barros, Guilherme Grossi Lopes Cançado, Eduardo Luiz Rachid Cançado, Débora Raquel Benedita Terrabuio, Cristiane Alves Villela-Nogueira, Maria Lucia Gomes Ferraz, Liana Codes, Vivian Rotman, Rodrigo Rocco, Guilherme Eduardo Felga, Diogo Delgado Dotta, Adrielly de Souza Martins, Liliana Sampaio Costa Mendes, Marlone Cunha da Silva, Elodie Bonfim Hyppolito, Geisa Perez Medina Gomide, Izabelle Venturini Signorelli, Maria Beatriz de Oliveira, Claudia Alexandra Pontes Ivantes, Maria Chiara Chindamo, Valéria Ferreira de Almeida e Borges, Luciana Costa Faria, Claudia Alves Couto

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引用次数: 0

摘要

背景和目的：事实证明，原发性硬化性胆管炎（PSC）会在肝移植（LT）后复发。一些研究发现，某些临床和实验室变量与白种人复发原发性硬化性胆管炎（rPSC）的风险增加有关。此外，有轶事报道称，rPSC 患者中存在新生胆管癌（CCA）。本研究旨在评估rPSC的患病率，确定其相关风险因素，并调查巴西高度混血人群中新生胆管癌的发生率：方法：对巴西胆汁淤积症研究组数据库中登记的所有因PSC而接受LT治疗的患者进行回顾性研究，以了解rPSC和新生CCA的发生情况：96名PSC患者（58名男性，平均年龄为32 ± 13岁）接受了LT治疗。经过90（39-154）个月的随访（FU），在29（30%）名患者中观察到了rPSC。rPSC与年龄、性别、并发或新生炎症性肠病、LT时的MELD评分或异体移植排斥反应之间无明显关联。唯一与疾病复发风险增加有关的因素是LT后的时间。虽然发生 rPSC 的患者存活率降低，但差异并不显著。只有一名女性患者在LT 11年后发生了rPSC后新发的CCA：结论：巴西有三分之一的PSC LT患者出现复发性PSC，并且与LT术后时间延长有关。尽管rPSC很常见，但它与移植物丢失风险升高或移植后存活率显著降低无关。

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Recurrence of Primary Sclerosing Cholangitis and De Novo Cholangiocarcinoma After Liver Transplantation: Results From the Brazilian Cholestasis Consortium

Background and Aim

Primary sclerosing cholangitis (PSC) has been shown to recur after liver transplantation (LT). Some studies have identified certain clinical and laboratory variables associated with an increased risk for recurrent PSC (rPSC) in Caucasians. Furthermore, de novo cholangiocarcinoma (CCA) has been reported anecdotally in patients with rPSC. This study aims to assess the prevalence of rPSC, identify its associated risk factors, and investigate the occurrence of de novo CCA in a highly admixed population from Brazil.

Methods

All patients submitted to LT for PSC enrolled in the Brazilian Cholestasis Study Group database were retrospectively reviewed for the occurrence of rPSC and de novo CCA.

Results

Ninety-six (58 males, mean age 32 ± 13 years) patients with PSC underwent LT. After 90 (39–154) months of follow-up (FU), rPSC was observed in 29 (30%) subjects. There were no significant associations between rPSC and age, gender, concurrent or de novo inflammatory bowel disease, MELD score at the time of LT or allograft rejection. The only factor associated with an increased risk of disease recurrence was time after LT. Although survival was decreased in patients who developed rPSC, this difference was not significant. Only one female patient developed de novo CCA after rPSC, 11 years after LT.

Conclusions

Recurrent PSC was observed in one-third of PSC LT patients in Brazil and was associated with longer time after LT. Despite its frequency, rPSC was not associated with a higher risk of graft loss or a significant reduction in posttransplant survival.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.