Liver transplantation (LT) is the only therapeutic option for primary sclerosing cholangitis (PSC), however, recurrence of PSC (rPSC) post-LT occurs at rates ranging from 9-47%. In this study, we aimed to define risk factors for rPSC post-LT and evaluate the impact of early recurrence (in the first 2 years post-LT) on patient survival.

A total of 101 liver transplants were done for 94 patients diagnosed with PSC over a period of 20 years at University of Alberta Hospital. The Kaplan-Meier curve was used to calculate survival and Cox's proportional regression hazard model was used to identify risk factors. A P-value of <0.05 was considered significant.

Age of patients at time of transplant ranged from 6 to 72 years old with a mean of 41 years. Liver grafts were obtained from deceased-donors in 82 transplants and from live-donors in 19 transplants. The overall patient survival was 81% during the follow-up period; survival at 1 year was 95%, at 5 years was 89% and at 10 years was 85%. rPSC occurred in 42 patients and overall recurrence free survival was 56%. The overall graft survival was 76%; graft survival at 1 year was 89%, at 5 years was 83% and at 10 years was 78%. Univariate analysis revealed that younger recipient age at time of transplant, previous biliary surgery, low serum albumin, positive cross-match, and older donor age are potential predictors of recurrence. Multivariate analysis revealed that positive cross-match (HR= 3.316, 95% CI (1.021-10.772)), and donor age (HR=1.043 (1.005-1.082)) are independent predictors of PSC recurrence. Early recurrence did not affect patient survival (P =0.972).

In conclusion, LT remains the best management for end-stage PSC. Positive cross-match and older liver grafts are predictors of rPSC post-LT and early recurrence of PSC does not affect patient survival.'<

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