Primary Sclerosing Cholangitis Recurrence After Liver Transplantation: A Systematic Review and Updated Meta-Analysis
Abstract
Background and aims: Primary sclerosing cholangitis (PSC) is an immune-mediated cholestatic liver disease. Liver transplantation (LT) remains the only definitive treatment for patients with advanced disease. However, recurrence of PSC (rPSC) after LT is still a significant clinical challenge. The aim of this study was to assess the prevalence and incidence of rPSC following transplantation and to identify factors associated with its occurrence.
Methods: We conducted a systematic review and meta-analysis of observational cohorts by searching PubMed, Embase and Cochrane for studies. Statistical analyses were conducted using R, applying a random-effects model with 95% confidence intervals.
Results: Twenty-nine studies were included, comprising 4682 patients who underwent LT for PSC (63.7% male). Most data originated from Europe (51.7%) and North America (29.2%), with additional cohorts from Asia (13.7%), South America (2.8%) and Oceania (2.6%). The worldwide pooled prevalence of rPSC was 18.66% (95% CI 15.33-22.52; I2 = 84%) between 1980 and 2024. As for the worldwide pooled incidence, rPSC occurred at 26.04 per 1000 person-years (95% CI 19.30-32.78; I2 = 76.1%). The continent with the highest rPSC prevalence was Oceania with 30.65% (95% CI 23.17-39.29; I2 = 13.8%) and South America had the highest incidence with 39.97 per 1000 person-years (95% CI 25.42-54.51). Younger recipient age (mean difference [MD] = 5.16 years, 95% CI 4.13-6.19; I2 = 51.3%), male sex (risk ratio [RR] =…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,682 participants or records.
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