Data regarding the effect of orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) on inflammatory bowel disease (IBD) course are scarce and conflicting.
To compare the incidence of refractory IBD in two groups (OLT and non-OLT) of patients affected by IBD and PSC.
An observational, multicentre, cohort retrospective study was conducted by the Italian Group for the study of IBD in Italy. The primary outcome was the need for biologic therapy or bowel resection for medically refractory IBD or hospitalization due to IBD relapse during the follow-up. Secondary outcomes were rate of colonic dysplasia, colorectal cancer, other solid tumours, lymphoma.
Eighty-four patients were included in the study. The primary outcome was not different between OLT and non-OLT groups (11/27, 40.7%, versus 20/57, 35.1%, respectively, p = 0.62). The lymphoma and other tumours (thyroid cancer, kidney cancer, ileal tumour, ovarian cancer, cervical cancer) rates were significantly higher in the OLT group (p = 0.04 and p = 0.005, respectively), at the limit of statistical significance for high-grade colonic dysplasia (p = 0.06).
OLT in patients affected by IBD and PSC is not a risk factor for a more severe IBD course, but it is associated with a higher occurrence of cancer.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Update on primary sclerosing cholangitis.Dig Liver Dis. 2010; 42: 390-400https://doi.org/10.1016/j.dld.2010.01.011
- Inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis.Am J Gastroenterol. 2013; 108: 1417-1425https://doi.org/10.1038/ajg.2013.163
- Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR).J Hepatol. 2012; 57: 675-688https://doi.org/10.1016/j.jhep.2012.04.015
- Effect of liver transplantation on inflammatory bowel disease in patients with primary sclerosing cholangitis.Hepatology. 2002; 35: 380-384https://doi.org/10.1053/jhep.2002.30695
- Solid organ transplantation in patients with inflammatory bowel diseases (IBD): analysis of transplantation outcome and IBD activity in a large single center cohort.PLoS One. 2015; 10e0135807https://doi.org/10.1371/journal.pone.0135807
- Clinical course of ulcerative colitis after liver transplantation in patients with concomitant primary sclerosing cholangitis and ulcerative colitis.Inflamm Bowel Dis. 2017; 23: 1160-1167https://doi.org/10.1097/MIB.0000000000001105
- Activity of inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis predicts poorer clinical outcomes.Inflamm Bowel Dis. 2020; izz325 (. Online ahead of print)https://doi.org/10.1093/ibd/izz325
- Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology.Gut. 1980; 21: 870-877https://doi.org/10.1136/gut.21.10.870
- 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: diagnosis and medical management.J Crohn's Colitis. 2017; 11: 3-25https://doi.org/10.1093/ecco-jcc/jjw168
- Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders.J Crohn's Colitis. 2017; 11: 649-670https://doi.org/10.1093/ecco-jcc/jjx008
- Natural history of established and de novo inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis.Inflamm Bowel Dis. 2018; 24: 1074-1081https://doi.org/10.1093/ibd/izx096
- Does the severity of primary sclerosing cholangitis influence the clinical course of associated ulcerative colitis?.Gut. 2011; 60: 1224-1228https://doi.org/10.1136/gut.2010.235408
- Clinical course and management of inflammatory bowel disease after liver transplantation.Transplantation. 1998; 65: 393-396
- The clinical course of ulcerative colitis after orthotopic liver transplantation for primary sclerosing cholangitis: further appraisal of immunosuppression post transplantation.Eur J Gastroenterol Hepatol. 2005; 17: 1379-1385
- The natural history of inflammatory bowel disease and primary sclerosing cholangitis after liver transplantation – a single-centre experience.Can J Gastroenterol. 2010; 24: 40-46
- Activity of ulcerative colitis before and after liver transplantation in primary sclerosing cholangitis: the hungarian experience.Transpl Proc. 2012; 44: 2164-2165https://doi.org/10.1016/j.transproceed.2012.07.098
- The effects of liver transplantation on the clinical course of colitis in ulcerative colitis patients with primary sclerosing cholangitis.Aliment Pharmacol Ther. 2012; 35 (n/a-n/a)https://doi.org/10.1111/j.1365-2036.2012.05067.x
- Immunosuppression after liver transplantation for primary sclerosing cholangitis influences activity of inflammatory bowel disease.Clin Gastroenterol Hepatol. 2013; 11: 517-523https://doi.org/10.1016/j.cgh.2012.12.027
- Inflammatory bowel disease after liver transplantation: risk factors for recurrence and de novo disease.Am J Transpl. 2006; 6: 1422-1429https://doi.org/10.1111/j.1600-6143.2006.01333.x
- Progressive primary sclerosing cholangitis requiring liver transplantation is associated with reduced need for colectomy in patients with ulcerative colitis.Clin Gastroenterol Hepatol. 2012; 10: 540-546https://doi.org/10.1016/j.cgh.2012.01.006
- Differences in colonic disease activity in patients with ulcerative colitis with and without primary sclerosing cholangitis: a case control study.Dis Colon Rectum. 1997; 40: 451-456
- The interrelation between sclerosing cholangitis and ulcerative colitis in patients undergoing liver transplantation.Ann Surg. 1992; 215 (discussion 604-5): 598-603
- European evidence-based consensus: inflammatory bowel disease and malignancies.J Crohn's Colitis. 2015; 9: 945-965https://doi.org/10.1093/ecco-jcc/jjv141
- ECCO-ESGAR guideline for diagnostic assessment in IBD. Part 1: initial diagnosis, monitoring of known IBD, detection of complications.J Crohn's Colitis. 2019; 13: 144-164https://doi.org/10.1093/ecco-jcc/jjy113
Published online: September 21, 2020
Accepted: September 15, 2020
Received: June 24, 2020
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.