The impact of inflammatory bowel disease post-liver transplantation for primary sclerosing cholangitis

Deepak Joshi*, Ingvar Bjarnason, Ajay Belgaumkar, John O'Grady, Abid Suddle, Michael A. Heneghan, Varuna Aluvihare, Mohammed Rela, Nigel Heaton, Kosh Agarwal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

76 Citations (Scopus)

Abstract

Background 
An association between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) is well recognized. However, the disease course of IBD following liver transplantation (LT) for PSC remains ill-defined. 

Aims and methods 
We aimed to assess the impact of IBD in patients that had undergone LT for PSC to help identify risk factors for flare and to assess the impact of IBD on graft survival. 

Results 
110 patients underwent LT for PSC (Oct 1990-Aug 2009) at King's College Hospital. 74 (67%) patients had concurrent IBD and 36 had PSC alone prior to transplant. 39 patients developed IBD (flare of IBD and de-novo) post transplant. Cumulative risk for IBD at 1-, 2-, 5- and 10-years was 16%, 24%, 38% and 72% respectively. Flare of IBD occurred in 33 patients with a mean time to flare of 30 +/- 28 months. De-novo IBD occurred in 6 patients (all UC). Mean time to diagnosis was 29 +/- 25 months. Multivariate cox-regression analysis identified active IBD at time of LT as a significant predictor of graft failure post LT (HR 10, CI 3-39, P = 0.001) and smoking at time of transplantation and subsequent cessation predictive of recurrent IBD post transplantation (HR 17, 2-180, P = 0.02). 

Conclusion 
In conclusion, smoking at time of LT was predictive of flare of IBD and active IBD at time of transplantation had a significant effect on graft survival. Medical therapy needs to be maximised in the pre-LT period. Patients with poorly controlled IBD refractory to medical therapy should be considered for colectomy at time of transplantation.

Original languageEnglish
Pages (from-to)53-61
Number of pages9
JournalLIVER INTERNATIONAL
Volume33
Issue number1
DOIs
Publication statusPublished - Jan 2013

Keywords

  • inflammatory bowel disease
  • liver transplantation
  • primary sclerosing cholangitis
  • thrombosis
  • DIFFERENT IMMUNOSUPPRESSIVE REGIMENS
  • ULCERATIVE-COLITIS
  • RISK-FACTORS
  • CLINICAL-COURSE
  • CANCER-RISK
  • T-CELLS
  • RECURRENCE
  • THROMBOEMBOLISM
  • MANAGEMENT
  • RECIPIENTS

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