Pretransplant prediction of prognosis after liver transplantation in primary sclerosing cholangitis using a Cox regression model

Liver transplantation remains the only treatment for patients with end-stag e primary sclerosing cholangitis (PSC); however, selection criteria for the procedure and its timing remains uncertain. The aim of this study was to i dentify pretransplant variables associated with survival after transplantat ion and to devise a Cox regression model for prediction of post-transplant survival, We studied 118 patients transplanted for PSC at the Queen Elizabe th Hospital, Birmingham, UK, being followed for up to 91/4 years after the procedure. The association between pretransplant data and the post-transpla nt survival up to 1 year was studied using the logrank test (univariate ana lyses) and Cox multiple regression analysis. Univariate analyses showed the following variables to be associated with a decreased post-transplant surv ival: high serum creatinine, high serum bilirubin, biliary tree malignancy, previous upper abdominal surgery, hepatic encephalopathy, ascites, and Cro hn's disease, whereas ulcerative colitis was associated with increased post -transplant survival (all P less than or equal to .05). The final multiple Cos regression model included the following significant variables: inflamma tory bowel disease, ascites, previous upper abdominal surgery, serum creati nine, and biliary tree malignancy (all P < .03). Biliary tree malignancy co uld be omitted from the Cos model with only slight loss of information. The results were validated using the data of 30 independent PSC patients from another center. These results can improve selection of patients with PSC fo r liver transplantation. The developed prognostic model for transplantation can be used in parallel with previously published prognostic models for no ntransplantation. The obtained prognostic estimates will provide additional information that is useful for optimal timing of liver transplantation in the individual patient.