Pouchitis disease course after orthotopic liver transplantation in patients with primary sclerosing cholangitis and an ileal pouch-anal anastomosis.
OBJECTIVE
Primary sclerosing cholangitis is associated with the development of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. This study determined the effect of liver transplantation for primary sclerosing cholangitis on the disease course of pouchitis.


METHODS
Seven patients with an ileal pouch-anal anastomosis for ulcerative colitis underwent liver transplantation for primary sclerosing cholangitis. The medical record was reviewed to determine the pouchitis activity and pattern (no pouchitis, single acute, recurrent acute, chronic) before and after transplantation.


RESULTS
Five of seven patients had pouchitis before transplant [recurrent acute (n = 3), chronic (n = 2)], and four of those five continued to have pouchitis after transplant (all chronic). Pretransplant sera were positive for antineutrophil cytoplasmic antibody in 6/6 patients, compared to 5/6 patients posttransplant. One patient with pouchitis pretransplant became negative for antineutrophil cytoplasmic antibody posttransplant but continued to have pouchitis.


CONCLUSIONS
Pouchitis occurs frequently in patients with primary sclerosing cholangitis and an ileal pouch-anal anastomosis for ulcerative colitis. Liver transplantation does not alter the disease course of pouchitis for most of these patients.
Division of Gastroenterology (Inflammatory Bowel Disease Clinic and Liver Transplant Clinic, Mayo Clinic, Rochester, Minnesota, USA.
B J
BJ
Zins
W J
WJ
Sandborn
C R
CR
Penna
C J
CJ
Landers
S R
SR
Targan
W J
WJ
Tremaine
R H
RH
Wiesner
R R
RR
Dozois
D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D005260:Female; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers; D006680:HLA Antigens