Impact of Inflammatory Bowel Disease and Azathioprine on Long‐Term Outcomes After Liver Transplantation for Primary Sclerosing Cholangitis

2021 ◽  
Author(s):  
Matthew Peverelle ◽  
Peter De Cruz ◽  
Sarang Paleri ◽  
Paul J. Gow
Keyword(s):  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
Long Term Outcomes ◽  
Inflammatory Bowel

Activity of Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis Predicts Poorer Clinical Outcomes

2020 ◽  
Vol 26 (12) ◽  
pp. 1901-1908 ◽  
Author(s):  
Matthew Peverelle ◽  
Sarang Paleri ◽  
Jed Hughes ◽  
Peter De Cruz ◽  
Paul J Gow
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
High Grade ◽  
Long Term Outcomes ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background The impact of inflammatory bowel disease (IBD) activity on long-term outcomes after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is unknown. We examined the impact of post-LT IBD activity on clinically significant outcomes. Methods One hundred twelve patients undergoing LT for PSC from 2 centers were studied for a median of 7 years. Patients were divided into 3 groups according to their IBD activity after LT: no IBD, mild IBD, and moderate to severe IBD. Patients were classified as having moderate to severe IBD if they met at least 1 of 3 criteria: (i) Mayo 2 or 3 colitis or Simple Endoscopic Score–Crohn’s Disease ≥7 on endoscopy; (ii) acute flare of IBD necessitating steroid rescue therapy; or (iii) post-LT colectomy for medically refractory IBD. Results Moderate to severe IBD at any time post-transplant was associated with a higher risk of Clostridium difficile infection (27% vs 8% mild IBD vs 8% no IBD; P = 0.02), colorectal cancer/high-grade dysplasia (21% vs 3% both groups; P = 0.004), post-LT colectomy (33% vs 3% vs 0%) and rPSC (64% vs 18% vs 20%; P < 0.001). Multivariate analysis revealed that moderate to severe IBD increased the risk of both rPSC (relative risk [RR], 8.80; 95% confidence interval [CI], 2.81–27.59; P < 0.001) and colorectal cancer/high-grade dysplasia (RR, 10.45; 95% CI, 3.55–22.74; P < 0.001). Conclusions Moderate to severe IBD at any time post-LT is associated with a higher risk of rPSC and colorectal neoplasia compared with mild IBD and no IBD. Patients with no IBD and mild IBD have similar post-LT outcomes. Future prospective studies are needed to determine if more intensive treatment of moderate to severe IBD improves long-term outcomes in patients undergoing LT for PSC.

scholarly journals Ulcerative colitis has an aggressive course after orthotopic liver transplantation for primary sclerosing cholangitis

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 639-644 ◽  
Author(s):  
G V Papatheodoridis ◽  
M Hamilton ◽  
P K Mistry ◽  
B Davidson ◽  
K Rolles ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
De Novo ◽  
Increased Risk ◽  
Inflammatory Bowel

Background—The course of inflammatory bowel disease after liver transplantation has been reported as variable with usually no change or improvement, but there may be an increased risk of early colorectal neoplasms. In many centres steroids are often withdrawn early after transplantation and this may affect inflammatory bowel disease activity.Aims—To evaluate the course of inflammatory bowel disease in primary sclerosing cholangitis transplant patients who were treated without long term steroids.Methods—Between 1989 and 1996, there were 30 patients transplanted for primary sclerosing cholangitis who survived more than 12 months. Ulcerative colitis was diagnosed in 18 (60%) patients before transplantation; two had previous colectomy. All patients underwent colonoscopy before and after transplantation and were followed for 38 (12–92) months. All received cyclosporin or tacrolimus with or without azathioprine as maintenance immunosuppression.Results—Ulcerative colitis course after transplantation compared with that up to five years before transplantation was the same in eight (50%) and worse in eight (50%) patients. It remained quiescent in eight and worsened in four of the 12 patients with pretransplant quiescent course, whereas it worsened in all four patients with pretransplant active course (p=0.08). New onset ulcerative colitis developed in three (25%) of the 12 patients without inflammatory bowel disease before transplantation. No colorectal cancer has been diagnosed to date.Conclusions—Preexisting ulcerative colitis often has an aggressive course, while de novo ulcerative colitis may develop in patients transplanted for primary sclerosing cholangitis and treated without long term steroids.

Impact of Preexisting Inflammatory Bowel Disease on the Outcome of Liver Transplantation for Primary Sclerosing Cholangitis

2020 ◽  
Vol 26 (11) ◽  
pp. 1477-1491
Author(s):  
Marie Irlès‐Depé ◽  
Stéphanie Roullet ◽  
Martine Neau‐Cransac ◽  
Jérôme Dumortier ◽  
Sébastien Dharancy ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
Inflammatory Bowel

Inflammatory bowel disease and liver transplantation for primary sclerosing cholangitis

2003 ◽  
Vol 15 (6) ◽  
pp. 657-663 ◽  
Author(s):  
Wim van de Vrie ◽  
Robert A de Man ◽  
Henk R van Buuren ◽  
W Ruud Schouten ◽  
Hugo W Tilanus ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Liver Transplantation ◽  
Primary Sclerosing Cholangitis ◽  
Bowel Disease ◽  
Sclerosing Cholangitis ◽  
Inflammatory Bowel
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