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Digestive Diseases and Sciences

, Volume 62, Issue 11, pp 3200–3209 | Cite as

Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis

  • Jacqueline B. Henson
  • Yuval A. Patel
  • Julius M. Wilder
  • Jiayin Zheng
  • Shein-Chung Chow
  • Lindsay Y. King
  • Andrew J. Muir
Original Article

Abstract

Background

There is increasing evidence for a heterogeneity of phenotypes in primary sclerosing cholangitis (PSC), but differences across the age spectrum in adults with PSC have not been well characterized.

Aims

To characterize phenotypic variations and liver transplantation outcomes by age group in adults with PSC.

Methods

The United Network for Organ Sharing database was used to identify waitlist registrations for primary liver transplantation in adults with PSC. Patients were split into three age groups: 18–39 (young), 40–59 (middle-aged), and ≥60 (older). Their clinical characteristics and outcomes on the waitlist and post-transplant were compared.

Results

Overall, 8272 adults with PSC were listed for liver transplantation during the study period, of which 28.9% were young, 52.0% were middle-aged, and 19.1% were older. The young age group had the greatest male predominance (70.0 vs. 66.2 vs. 65.1%, p = 0.001), the highest proportion of black individuals (20.0 vs. 11.0 vs. 5.5%, p < 0.001), and the most patients listed with concomitant autoimmune hepatitis (2.2 vs. 1.0 vs. 0.8%, p < 0.001). Older patients experienced the greatest waitlist and post-transplant mortality. Graft survival was greatest in the middle-aged group. Young patients were most likely to experience acute rejection (31 vs. 22.8 vs. 18.0%, p < 0.001) and have graft failure due to chronic rejection or PSC recurrence (47.8 vs. 42.3 vs. 17.9%, p < 0.001).

Conclusions

Age-related differences exist among adults with PSC and are associated with outcomes pre- and post-transplant. Young patients may have a more robust immune-related phenotype that is associated with poorer graft survival. Future studies are needed to further investigate these findings.

Keywords

Sclerosing cholangitis Liver transplantation Phenotype Treatment outcome Age factors 

Abbreviations

AIH

Autoimmune hepatitis

CI

Confidence interval

DCD

Donation after cardiac death

HCC

Hepatocellular carcinoma

HR

Hazard ratio

IBD

Inflammatory bowel disease

ICU

Intensive care unit

INR

International normalized ratio

IQR

Interquartile range

MELD

Model for End-Stage Liver Disease

OPTN

Organ Procurement and Transplantation Network

PSC

Primary sclerosing cholangitis

SHR

Subhazard ratio

UNOS

United Network for Organ Sharing

Notes

Acknowledgments

This work was supported in part by Health Resources and Services Administration Contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jacqueline B. Henson
    • 1
  • Yuval A. Patel
    • 2
  • Julius M. Wilder
    • 2
    • 4
  • Jiayin Zheng
    • 3
  • Shein-Chung Chow
    • 3
    • 4
  • Lindsay Y. King
    • 2
  • Andrew J. Muir
    • 2
    • 4
  1. 1.Duke University School of MedicineDurhamUSA
  2. 2.Division of Gastroenterology, Department of MedicineDuke University School of MedicineDurhamUSA
  3. 3.Department of BiostatisticsDuke University School of MedicineDurhamUSA
  4. 4.Duke Clinical Research InstituteDurhamUSA

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