Recurrence of primary Sclerosing Cholangitis after liver transplantation: Challenges, insights, and future directions

Primary sclerosing cholangitis (PSC) is an immune-mediated fibro-obliterative disease of the biliary tree which culminates in biliary cirrhosis and decompensated liver failure. Increasing in incidence, PSC comprises a growing indication for liver transplantation (LT) with LT remaining the only proven life-prolonging therapy in patients with PSC. Recurrence of PSC (rPSC) after LT is however poorly understood and poses a further challenge due to heterogeneity in diagnostic criteria and proposed negative associations with graft failure and overall survival. This review explores the current literature surrounding rPSC including diagnosis, epidemiology, therapeutic options and patient outcomes. We discuss the challenges in the management of rPSC. Given the scarcity of literature and frequency of re-transplantation for rPSC, further clinical investigation is necessary to identify risk factors and effective therapies in this cohort of patients.