Inflammatory bowel disease and liver transplantation for primary sclerosing cholangitis.
OBJECTIVE
To compare the outcome of liver transplantation in primary sclerosing cholangitis (PSC) patients with and without inflammatory bowel disease (IBD), and to analyse the influence of the transplantation on the course of IBD.


METHODS
Retrospective analysis of the data regarding PSC, IBD, and liver transplantation in all patients transplanted for PSC.


METHODS
Single university transplantation centre.


RESULTS
Thirty-one patients were transplanted for PSC, of whom 18 had IBD before liver transplantation. There were no differences in complication rate and outcome between patients with and patients without IBD. Before liver transplantation, the IBD course was active in three patients and quiescent in 14 patients (one patient was not evaluable). After liver transplantation, the course was active in five (one de-novo IBD) patients and quiescent in 13 patients. Exacerbations of IBD occurred in ten patients during treatment with steroids and a calcineurin blocker. Five patients with long-standing and extensive colitis developed colorectal neoplasia after liver transplantation (two colorectal cancer, two extensive dysplasia, one leiomyosarcoma).


CONCLUSIONS
Concomitant IBD had no detrimental influence on the outcome of liver transplantation in patients with PSC. The course of IBD was not altered after liver transplantation. Immunosuppression including steroids did not prevent exacerbations of IBD. The development of colorectal neoplasia is a serious threat to patients with IBD and PSC after liver transplantation.
van de Vrie
Wim
W
Department of Gastroenterology and Hepatology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.
de Man
Robert A
RA
van Buuren
Henk R
HR
Schouten
W Ruud
WR
Tilanus
Hugo W
HW
Metselaar
Herold J
HJ
D000293:Adolescent; D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome