Epidemiology and Risk Factors for Infections in Myelodysplastic Syndromes

Abstract Background: Patients with MDS are at high risk of developing infections, which still represent the most frequent complications and the main cause of mortality and morbidity. We conducted a retrospective study with the aim of evaluating incidence, characteristics and outcome of infectious events in patients with myelodysplastic syndromes (MDS) and the risk factors associated with them. Patients and methods: 200 patients with MDS or LMMC followed by the Ancona Hematology Clinic in the last 15 years were included. In this group, we evaluated severe infectious episodes and associated risk factors, relating to patient, disease and therapy. Results: In a cohort of 200 patients, we detected 65 cases of infections of higher than third grade according to WHO. Pneumonia is the most frequent infection, especially on a bacterial basis. Risk factors that have shown significant association with infections ≥ G3 are: comorbidity (p = 0.0086), hemoglobin level (P = 0.0111), neutropenia (P = 0.0152), transfusion dependence during the course of disease (P <0.0001) and hypomethylating therapy (P = 0.0014). A subanalysis confirmed comorbidities as risk factors for the development of pneumonia (P = 0.0322) and azacitidine therapy as a risk factor for sepsis (P = 0.0038). The overall survival of the cohort is approximately 7.5 months and the predictive factors of survival are patient age (P = 0.0005), WHO disease class (P = 0.001), R-IPSS (P <0.0001) and transfusion-dependence during the course of the disease (P <0.0001). Multivariate analysis confirmed age (P = 0.0002), R-IPSS (P = 0.0043) and transfusion-dependence (P = 0.0006) as predictors of survival. Infections above grade 3 do not impact survival. Otherwise, there was a trend of reduced survival in patients who had pneumonia (P = 0.0612) or sepsis (P = 0.0927). Conclusion: Patients with MDS have a high probability of encountering an infectious problem in the course of the natural history of the disease. In one out of five cases, there are more than one infectious event. Particularly at risk of infection are patients with comorbidities, neutropenia (PMN <800 / mm³), significant transfusion needs and on therapy with hypomethylating agents. These patients should be carefully monitored for infectious complications. Disclosures No relevant conflicts of interest to declare.

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History of Autoimmune Disease Is Associated with Increased Risk for Myelodysplastic Syndromes

Blood ◽

10.1182/blood-2019-130940 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3014-3014

Author(s):

Michelle A. Roesler ◽

Amy Linabery ◽

Michaela Richardson ◽

Adina Cioc ◽

Betsy A Hirsch ◽

...

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Autoimmune Disease ◽

Myelodysplastic Syndromes ◽

Conflicts Of Interest ◽

Population Based ◽

Case Control ◽

Increased Risk ◽

History Of ◽

Autoimmune Condition

Background With the exception of therapy related MDS due to treatment with alkylating agents and/or radiation or with a topoisomerase II inhibitor, little is known about the etiology of myelodysplastic syndromes (MDS). A few studies have evaluated pre-existing medical conditions as risk factors for MDS, with evidence suggesting that autoimmune disease is associated with an increased risk of MDS. Here, we evaluated associations between history of autoimmune disease, overall and by individual disease subtype, and risk of MDS in a population-based case control study. Methods MDS cases were identified by rapid case ascertainment through the population-based Minnesota Cancer Surveillance System (MCSS). Participants were recruited if they were diagnosed with MDS between April 1, 2010 and October 31, 2014. Eligibility criteria included residence in Minnesota, age at diagnosis between 20 and 85 years, and ability to understand English or Spanish. Centralized pathology and cytogenetics review were conducted to confirm diagnosis and classify by subtypes. Controls were identified through the Minnesota State driver's license/identification card list. History of autoimmune disease was reported using a self-administered questionnaire; proxy interviews were not conducted. Unconditional logistic regression with adjustment for age, sex and confounders (education, NSAID use, benzene exposure, BMI) was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CI) for autoimmune disease and MDS. Results A total of 399 cases with a confirmed diagnosis of MDS and 1399 controls were included. Cases were significantly more likely to report a diagnosis of any autoimmune disease when compared with controls (OR=1.49, 95% CI 1.13-1.97). As illustrated in Figure 1, specific associations were observed for hypothyroidism (OR=2.07, 95% CI 1.39-3.08), ulcerative colitis (OR=2.26, 95% CI 1.09-4.69), Crohn's disease (OR=3.88, 95% CI 1.23-12.2), and systemic lupus erythematosus (SLE; OR=7.52, 95% CI 1.98-28.6). Autoimmune conditions were more commonly reported in both female cases and female controls when compared with males; however, associations for hypothyroidism and ulcerative colitis were significantly associated with MDS in males in an analysis stratified by sex. Associations between autoimmune disease and MDS remained statistically significant after exclusion of therapy-related MDS cases. Discussion Our results validate previous findings of an association between autoimmune disease and MDS risk from population-based registry studies and case-control studies. In addition, our results provide additional evidence to suggest that this association is largely driven by hypothyroidism, inflammatory bowel disease, and SLE. This increased MDS risk following a diagnosis for an autoimmune condition is hypothesized to be due to shared genetic or environmental risk factors, treatment for autoimmune diseases, altered immune surveillance or damage to the bone marrow caused by the autoimmune condition. Further studies are required to confirm which of these is the most plausible explanation. Disclosures No relevant conflicts of interest to declare.

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Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

European Journal of Inflammation ◽

10.1177/2058739220960547 ◽

2020 ◽

Vol 18 ◽

pp. 205873922096054

Author(s):

Faiz Ullah Khan ◽

Yu Fang ◽

Zakir Khan ◽

Farman Ullah Khan ◽

Zafar Iqbal Malik ◽

...

Keyword(s):

Risk Factors ◽

Transurethral Resection ◽

Surgical Site Infections ◽

Exploratory Laparotomy ◽

Cross Sectional Study ◽

Surgical Patients ◽

Related Factors ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Associated Risk Factors

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

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Liver Cancer in Guatemala: An Analysis of Mortality and Incidence Trends From 2012 to 2016

Journal of Global Oncology ◽

10.1200/jgo.18.00179 ◽

2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Alba J. Kihn-Alarcón ◽

María F. Toledo-Ponce ◽

Angel Velarde ◽

Ximing Xu

Keyword(s):

Risk Factors ◽

Liver Cancer ◽

Secondary Analysis ◽

Mortality And Morbidity ◽

Incidence Trends ◽

The North ◽

B Virus ◽

Morbidity Data ◽

Associated Risk Factors ◽

Late Stages

PURPOSE Guatemala has the highest mortality and incidence of liver cancer in Central and South America. The aim of this study is to describe the extent of liver cancer in the country from 2012 to 2016 and the associated risk factors. METHODS A secondary analysis was performed using liver cancer mortality and morbidity data and data on risk factors, such as hepatitis B virus infection, cirrhosis, and alcoholism. RESULTS Analysis revealed that liver cancer causes approximately 20% of cancer deaths in the country, is more frequent in the population older than age 65 years old, and is increasing in those age 30 to 44 years. More than 25% of deaths occurred in the North and West regions. The incidence of major risk factors for development of liver cancer has decreased. CONCLUSION The high mortality of liver cancer compared with its incidence indicates that most patients are diagnosed at late stages. To reduce the burden of liver cancer, creation of strategies for earlier detection is needed.

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Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

10.53350/pjmhs211592451 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2451-2453

Author(s):

Shahid Iqbal ◽

Muhammad Fareed Khan ◽

Raja Imtiaz Ahmed ◽

Shahab Saidullah ◽

Nisar Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Folic Acid ◽

Congenital Heart ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Febrile Illness ◽

Care Hospital ◽

Younger Age ◽

History Of ◽

Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

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Pressure ulcer incidence in acute care settings: a multicentre prospective study

Journal of Wound Care ◽

10.12968/jowc.2021.30.11.930 ◽

2021 ◽

Vol 30 (11) ◽

pp. 930-938

Author(s):

Ma'en Aljezawi

Keyword(s):

Risk Factors ◽

Acute Care ◽

Pressure Ulcer ◽

Conflicts Of Interest ◽

White Blood Cells ◽

Albumin Level ◽

Advisory Panel ◽

Hospitalised Patients ◽

Acute Care Settings ◽

Associated Risk Factors

Objective: Pressure ulcers (PUs) are one of the most commonly occurring complications in hospitalised patients. Knowing the size of the problem and its risk factors will help in preventing it. The aim of this study is to measure the incidence of PUs in acute care settings in Jordan and to explore associated risk factors. Method: A prospective incidence study for hospitalised patients in Jordan according to the European Pressure Ulcer Advisory Panel methodology. All patients admitted into four Jordanian hospitals over a period of six months were included. Results: The cumulative incidence rate was 0.48%. Using multivariate analysis, a low albumin level, elevated white blood cells, incontinence and having more chronic illnesses were significantly associated with acquiring PUs. Conclusion: Incidence of PUs in Jordan is lower when compared with other parts of the world; this could be related to the relatively younger Jordanian population compared with other populations. Declaration of interest: The author has no conflicts of interest to declare.

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Prevalence of postnatal depression and associated risk factors among South Asian mothers living in a newly developing country

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2016.v9i6.12900 ◽

2016 ◽

Vol 9 (6) ◽

pp. 57

Author(s):

Hashim Mohamed

Keyword(s):

Risk Factors ◽

Health Care ◽

Primary Health Care ◽

South Asian ◽

Postnatal Depression ◽

Marital Problems ◽

Primary Health ◽

History Of ◽

Associated Risk Factors ◽

Asian Mothers

AbstractIntroductionPostnatal Depression (PND) is a major health problem affecting mother, her child and family. Its prevalence and associated risk factors among South Asian mothers (SAM) living in Qatar remain unknown. The objectives of this study were to estimate the prevalence of PND among (SEAM) in Qatar and to correlate risk factors contributing to the development of PND.Materials and methodsA total of (285 ) (SAM)females who were six months postpartum were interviewed as part of a prospective study conducted in primary health care centers in Qatar. PND symptoms were defined as present when subjects had an Edinburgh Postnatal Depression Scale score of 10 or higher. Descriptive statistics were used for summarizing the study and outcome variables. The χ2 test and ORs with 95% confidence intervals (CIs) were used for observation and quantifying the association between different variables. Multivariate binary logistic regression was used to identify the independent associated factors of PPD. P≤0.05 was considered significant. Variables included were age , occupation, education level ,previous psychiatric history ,comorbidities , ,history of depression during current pregnancy, history of anxiety during current pregnancy, number of previous pregnancies, strong social support, husband support, marital problem before pregnancy and ongoing marital problems during current pregnancy.Results The prevalence of postnatal depression among 285 respondents was 33.2% .several psychosocial risk factors were significantly associated with postnatal depression and, after multiple regression analysis, a history of depressive illness ,anxiety ,marital problems before delivery ,a history of diabetes and asthma ,history of congenital malformations ,and lack of mother support.Other variables, including age, parity, education, occupation, and delivery type, were not significantly correlated (P=0.15–0.95), but marginally indicative of the risk of depressive symptoms.ConclusionThis study showed a high rate of depressive symptoms among(SAM) six months Postpartum . Future screening protocols must be employed at primary care level and hospital based clinics in Qatar to detect and treat post natal depression.Keywords: postnatal depression, South Asians, primary health care ,Doha, EPDS

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Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran

The Open Neurology Journal ◽

10.2174/1874205x02014010095 ◽

2020 ◽

Vol 14 (1) ◽

pp. 95-102

Author(s):

Mohammad Vafaee-Shahi ◽

Elaheh Soltanieh ◽

Hossein Saidi ◽

Aina Riahi

Keyword(s):

Risk Factors ◽

Status Epilepticus ◽

Brain Imaging ◽

Morbidity And Mortality ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Imaging Results ◽

History Of ◽

Abnormal Brain ◽

Febrile Status Epilepticus

Background: Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus. Methods: This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study. Results: The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36% versus 14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology. Conclusion: Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.

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945. Prevalence of HIV Associated Non-AIDS Conditions and Associated Risk Factors among Hospitalized HIV-infected Patients in India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1131 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S504-S505

Author(s):

Amyeo A Jereen ◽

Celia Kucera ◽

Saniya Pervin ◽

Muralidhar Varma ◽

Radhakrishnan Rajesh ◽

...

Keyword(s):

Risk Factors ◽

Transmitted Disease ◽

Multivariate Logistic Regression Analysis ◽

Patient Risk ◽

Sexually Transmitted ◽

Factors Associated ◽

Immunodeficiency Virus ◽

History Of ◽

Artery Disease ◽

Associated Risk Factors

Abstract Background HIV-associated non-AIDS (HANA) conditions are becoming common as People Living with Human Immunodeficiency Virus (PLWHIV) age. However, data estimating the prevalence of HANA conditions and associated risk factors is lacking in developing countries. This study evaluates reasons for hospitalizations among PLWHIV in Udupi, India in the antiretroviral era, and describes associated risk factors. Methods Demographic and clinical data were extracted from medical charts of 1280 HIV-infected patients 18 years and older who were admitted to Kasturba Hospital, Manipal, India between January 1, 2013 and December 31, 2017, for a total of 2157 hospitalizations. Primary reasons for hospitalization were categorized into AIDS-defining vs Non-AIDS-defining and HANA vs Non-HANA conditions (Fig 1). Multivariate logistic regression analysis was performed to estimate demographic and clinical factors associated with hospitalizations due to AIDS-defining illness and HANA conditions. Categorization of Reasons for Hospitalization Results Patients’ median age was 45 (18-80) years; 70% male. Median age of patients with AIDS-defining illness (45% of hospitalizations) was lower at 44 (18-75) years compared with HANA (15% of hospitalizations) at 48 (21-80) years. Age (OR, 95% CI) (0.985, 0.974-0.995), admission CD4 (0.998, 0.997 - 0.998), history of hypertension (HTN) (0.59, 0.42-0.82), stroke (0.49, 0.24 - 0.93), diabetes (1.56, 1.10 - 2.19), and AIDS-defining cancers (1.74, 1.05 - 2.89) were associated with AIDS-defining hospitalizations (Fig 2). Additionally, age (1.016, 1.001 - 1.031), history of HTN (1.70, 1.16 - 2.46), coronary artery disease (CAD) (4.02, 1.87- 9.02), chronic kidney disease (CKD) (2.30, 1.15 - 4.61), stroke (2.93, 1.46 - 5.96), Hepatitis B (3.32, 1.66- 6.72), Hepatitis C (16.1, 2.84 - 314), sexually transmitted disease (STD) (3.76, 1.38- 10.8), and HANA-associated cancer (2.44, 1.28- 6.42) were associated with HANA hospitalizations (Fig 3). Patient Risk Factors for AIDS-related Hospitalization Patient Risk Factors for HANA-related Hospitalization Conclusion Prevalence of HANA conditions was lower than AIDS-defining illnesses possibly because of a younger population. Patients with AIDS-defining illnesses were also likely to have HANA conditions. Early detection and effective treatment of both HIV and HANA conditions is essential to decrease hospitalizations in low-resource settings. Disclosures All Authors: No reported disclosures

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Study on Associated Risk Factors of Hypertension at Sipaghat of Sindhupalchowk District, Nepal

Nepalese Journal of Statistics ◽

10.3126/njs.v1i0.18818 ◽

2017 ◽

Vol 1 ◽

pp. 73-82

Author(s):

Naresh Manandhar

Keyword(s):

Risk Factors ◽

Family History ◽

Alcohol Consumption ◽

Lifestyle Modification ◽

Percent Level ◽

Cross Sectional Study ◽

Cross Sectional ◽

History Of ◽

Family History Of Hypertension ◽

Associated Risk Factors

Background: Hypertension is a progressive cardiovascular syndrome arising from complex and interrelated etiologies. Males have slightly higher prevalence than female in most of countries of Southeast-Asian region.Objective: The objective of study is to find out prevalence and the risk factors of hypertension at Sipaghat, Sindhulchowk, Nepal.Materials and Methods: A cross-sectional study was conducted at Sipaghat of Sindhupalchowk district in May 2016 and 260 persons were selected randomly. Results: The prevalence of hypertension was higher in male (25.4%) than female (17.4%). Mean age of study population was 42.08 years with standard deviation, 15.95 years. Variables namely age group, smoking, alcohol consumption and family history of hypertension were found to be significant at 5 percent level of significance. Alcohol consumption and smokers have more than two times higher chance of getting hypertension compared to alcohol non-consumer and nonsmoker with 95% confidence intervals were 1.08-4.80 and 1.21-6.10, respectively. Persons with family history of hypertension have 3.8 times more chance of getting hypertension compared to no family history of hypertension with 1.89-7.61 of 95% confidence interval.Conclusion: Lifestyle modification reduces blood pressure which prevents or delays the incidence of hypertension. Hypertension can be controlled and prevented by modifying the lifestyle. People should be advised to avoid modifiable risk factors of hypertension like smoking, consumption of alcohol and physical inactivity through health education programs.Nepalese Journal of Statistics, 2017, Vol. 1, 73-82

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Recurrent Primary Sclerosing Cholangitis: Current Understanding, Management, and Future Directions

Seminars in Liver Disease ◽

10.1055/s-0041-1730950 ◽

2021 ◽

Author(s):

Kristel K. Leung ◽

Maya Deeb ◽

Sandra E. Fischer ◽

Aliya Gulamhusein

Keyword(s):

Risk Factors ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Large Scale ◽

Related Factors ◽

Future Directions ◽

History Of ◽

Inflammatory Bowel ◽

Specific Factors ◽

Associated Risk Factors

AbstractPatients with primary sclerosing cholangitis (PSC) constitute 5 to 15% of patients listed for liver transplantation worldwide. Although post-transplant outcomes are favorable, recurrent PSC (rPSC) occurs in an important subset of patients, with higher prevalence rates reported with increasing time from transplant. Given its association with poor graft outcomes and risk of retransplant, effort has been made to understand rPSC, its pathophysiology, and risk factors. This review covers these facets of rPSC and focuses on implicated risk factors including pretransplant recipient characteristics, inflammatory bowel-disease-related factors, and donor-specific and transplant-specific factors. Confirming a diagnosis of rPSC requires thoughtful consideration of alternative etiologies so as to ensure confidence in diagnosis, management, subsequent risk assessment, and counseling for patients. Unfortunately, no cure exists for rPSC; however, future large-scale efforts are underway to better characterize the natural history of rPSC and its associated risk factors with hopes of identifying potential key targets for novel therapies.

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