[Clinical course of inflammatory bowel disease in patients transplanted for primary sclerosing cholangitis].
Primary sclerosing cholangitis is frequently associated with inflammatory bowel disease.


OBJECTIVE
to evaluate the evolution of IBD in patients transplanted for PSC and the incidence of severe dysplasia/carcinoma.


METHODS
we included 32 patients transplanted between 1988 and 2006 for PSC. Median follow-up: 8.7 years (1-20 y). All patients were evaluated pre-OLT with colonoscopy and multiple intestinal biopsies. Post-OLT surveillance colonoscopies were performed every 12 months.


RESULTS
of 32 patients included, 26 had inflammatory bowel disease pre-OLT (ulcerative colitis 25, Crohn's disease 1). 12 patients had active intestinal disease pre-OLT and 2 patients had moderate dysplasia but were not surgically treated due to the severity of their liver disease. Among the 26 patients with IBD pre-OLT, 2 died in the postoperative period due to complications related to the transplantation procedure. Among the other 24 patients, 16 had a quiescent colonic disease post-OLT. Among them, 12 had quiescent disease pre-OLT and 4 showed improvement in their colonic symptoms after transplantation. Eight patients were symptomatic pre-OLT and had a transitory improvement in their symptoms post-OLT, with worsening of their intestinal disease by 5.7 +/- 2.8 months after transplantation. Three patients developed severe dysplasia or colonic cancer.


CONCLUSIONS
over half of patients transplanted for PSC presented with quiescent intestinal disease. Yet, there was a group of patients that worsened their colonic symptoms and had a high incidence of dysplasia/carcinoma. It is necessary to maintain an adequate colonic surveillance even in the absence of colonic symptoms or active disease.
Villamil
Alejandra
A
Sección de Hígado y Trasplante Hepático, Servicio de Gastroenterología, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina. alejandra.villamil@hospitalitaliano.org.ar
De Paula
Juan Andrés
JA
Galdame
Omar
O
Piccioni
Héctor
H
Ciardullo
Miguel
M
De Santibañes
Eduardo
E
Gadano
Adrián
A
D000328:Adult; D015209:Cholangitis, Sclerosing / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult