S2868 Increased Risk of Liver Transplant Rejection or Failure in Patients With Primary Sclerosing Cholangitis: A Propensity-Matched Retrospective Cohort Study Using a Global Federated Health Network

Introduction: Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease that often necessitates liver transplantation. However, the impact of underlying PSC on post-transplant outcomes remains under-investigated. We aimed to compare the risk of liver transplant rejection or failure in recipients with and without PSC. Methods: We utilized the TriNetX Global Collaborative Network, which aggregates data from 145 healthcare organizations. Adults (≥18 years) who underwent liver transplantation were divided into 2 cohorts: (1) patients with a diagnosis of PSC prior to transplantation (n = 1,345) and (2) non-PSC liver transplant recipients (n = 1,345), matched 1:1 using propensity scores based on demographics and pre-transplant immunosuppressive medication use. The primary composite outcome was liver transplant rejection or failure, defined by International Classification of Diseases, Tenth Revision (ICD-10) codes T86.41 and T86.42. Risk analysis and Kaplan-Meier survival analysis were performed, excluding patients with pre-existing outcomes. Results: After exclusion, 1,102 patients with PSC and 1,294 without PSC were included in the outcome analysis. The incidence of transplant rejection or failure was significantly higher in the PSC cohort compared to the non-PSC group (17.3% vs 9.7%; risk ratio 1.78, 95% CI: 1.44–2.20; P < 0.001). Kaplan-Meier analysis showed a lower survival probability in the PSC group at the end of follow-up (62.4% vs 82.6%, log-rank P < 0.001). The hazard ratio for rejection or failure in the PSC group was 1.77 (95% CI: 1.41–2.22). The median follow-up was 41.4 months for PSC patients and 36.1 months for non-PSC patients. Conclusion: Patients with PSC undergoing liver transplantation are at significantly higher risk of graft rejection or failure compared to those without PSC. These findings underscore the need for enhanced post-transplant surveillance and individualized immunosuppressive strategies in this high-risk population.