Effect of liver transplantation on inflammatory bowel disease in patients with primary sclerosing cholangitis.
This report investigates the influence of liver transplantation and concomitant immunosuppression on the course of progression of inflammatory bowel disease (IBD) and discusses statistical methodology appropriate for such settings. The data on 303 patients who underwent liver transplantation for primary sclerosing cholangitis (PSC) were analyzed using person-time analysis and Cox regression, with the duration of IBD as the time variable and transplantation as a segmented time-dependent covariate, to take into account both posttransplant and pretransplant history of IBD. The need for colectomy and appearance of colorectal cancer were taken as outcome measures. The only significant risk factor in the multivariate model for colectomy was transplantation itself, which increased the risk of colectomy due to intractable disease (Wald statistic; P =.001). None of the variables available for analysis were found to influence the risk of colon cancer significantly. Graphs showing the dependence of the instantaneous risk of cancer on the time from onset of IBD and its independence from the latter in the case of colectomy are presented. The use of a unique statistical methodology described for the first time in this setting led us to the somewhat surprising conclusion that transplantation and concomitant use of immunosuppression accelerate the progression of IBD. At the same time, transplantation does not affect the incidence of colorectal cancer. These results confirm the findings of some recent studies and can potentially shed new light on the disease pathogenesis.
Dvorchik
Igor
I
Section of Biostatistics, Thomas E. Starzl Transplantation Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. idv@imap.pitt.edu
Subotin
Michael
M
Demetris
A Jake
AJ
Fung
John J
JJ
Starzl
Thomas E
TE
Wieand
Samuel
S
Abu-Elmagd
Kareem M
KM
D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000601:surgery*; D003082:Colectomy; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008962:Models, Theoretical; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis