In summary, recurrent PSC is now established as an important clinical outcome after liver transplantation. Over time, this problem is likely to increase and exert more impact on patient and graft survival. Thus, further large-scale longitudinal multicenter studies will be necessary to assess the impact of recurrent PSC on long-term outcomes. The mechanism for recurrent PSC is unknown, but current data lend support to an association with rejection and corticosteroid therapy in susceptible patients. With respect to this growing problem, several critical questions can be posed as priorities for researchers in the future. What effect will novel immunosuppressive medications or rapid corticosteroid withdrawal protocols have on the incidence and severity of recurrent disease? Which patients are more likely to develop recurrence? What medication should be administered as preventive therapy for recurrence? Understanding the pathogenesis of the disease is a key to answering these questions.
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