Background : Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease often requiring liver transplantation (LT). However, post-transplant outcomes remain heterogeneous, while frequent association with ulcerative colitis (UC) adds difficulty to post-transplant management. This study aim to evaluate clinical outcomes, including UC progression, recurrence, and biliary complications, to identify factors associated with poor outcomes in PSC patients who underwent LT.

Methods : 18 PSC patients who received LT were retrospectively analyzed. Clinical data including graft rejection, PSC recurrence, biliary complications, UC status, and survival outcomes, were collected. Relationships between outcomes and factors such as the interval between PSC/UC diagnosis and LT were examined.

Results : Median follow up period after LT was 69 months. Among the 18 cases, 10 patients were preoperatively diagnosed of UC. 5 experienced UC aggravation post-transplant, while the remaining 5 remained stable. Surprisingly, no new-onset UC was observed in the 8 patients without prior UC diagnosis. Other outcomes included PSC recurrence in 5 patients, biliary complications in 11, and graft rejection in 4. Two patients required re-transplantation (due to chronic rejection and PSC recurrence), and 4 patients died during follow-up. The timing of LT relative to PSC or UC diagnosis was not significantly associated with any complications.

Conclusions : It was noted that half of PSC patients with preoperative UC experienced exacerbation event after LT, while no new-onset UC developed in patients without prior diagnosis. Poor outcomes, including PSC recurrence and biliary complications, were common, though unrelated to the timing of surgery. Further studies are needed for individualized postoperative care to improve outcomes.