# Graft and Patient Survival After Liver Transplantation for Primary Sclerosing Cholangitis: A French National Cohort Study

## TL;DR

This study examines survival and graft outcomes after liver transplantation for primary sclerosing cholangitis in a French cohort.

## Contribution

The study identifies key factors affecting patient and graft survival after liver transplantation for PSC in a large national cohort.

## Key findings

- Mid-term patient survival is affected by recurrence of cholangiocellular carcinoma.
- Long-term survival is impacted by insufficient colorectal cancer screening.
- Graft survival is compromised by recurrent PSC and cellular rejection.

## Abstract

A significant proportion of patients presenting a primary sclerosing cholangitis (PSC) will require liver transplantation (LT). The present study aimed to investigate graft loss and patient death in a large cohort of patients.

We conducted a nationwide multicenter retrospective study including all adult patients transplanted for PSC in France From 1985 to 2019.

Were included 571 patients; median follow‐up after LT was 89.0 months (IQR, 43.0–151.0). Patient survival at 5, 10 and 20 years after LT was 88.2%, 81.2% and 62.6%. After exclusion of patients who died during the first month after LT, 37 patients (6.6%) died during the first 2 years and the main cause was malignancies (n = 15, 40.5%, including 12 cases of recurrent cholangiocellular carcinoma). After 2 years, 90 patients (17.2%) died; the two main causes were malignancies (n = 36, 40.0%, including 13 cases of colorectal cancer) and sepsis (n = 23, 25.6%, of which 7 were related to recurrent PSC). Graft survival at 5, 10 and 20 years was 89.5%,78.7% and 62.7%. Independent factors associated with late patient death (after 2 years) were an older age at LT, a bilio‐digestive anastomosis and the use of preventive UDCA; independent factors associated with late graft loss were recurrent PSC, cellular rejection, a younger age at LT, and the use of tacrolimus (protective).

Our results emphasise that the prognosis after LT for PSC could be improved by better detection of cholangiocellular carcinoma before LT, and colorectal cancer after LT.

Patient mid‐term (< 2 years) survival is impaired due to recurrence of cholangiocellular carcinoma, especially incidental cholangiocellular carcinoma. Patient long‐term survival is impaired due to colorectal cancer, for which screening (colonoscopy) is insufficient. Graft survival is impaired due to recurrence of primary sclerosing cholangitis, often requiring re‐transplantation.