title: The impact of inflammatory bowel disease post-liver transplantation for primary sclerosing cholangitis.
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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Institute of Liver Studies, King's College Hospital, London, UK. d.joshi@nhs.net
authors: Deepak
authors: D
authors: Joshi
authors: Ingvar
authors: I
authors: Bjarnason
authors: Ajay
authors: A
authors: Belgaumkar
authors: John
authors: J
authors: O'Grady
authors: Abid
authors: A
authors: Suddle
authors: Michael A
authors: MA
authors: Heneghan
authors: Varuna
authors: V
authors: Aluvihare
authors: Mohammed
authors: M
authors: Rela
authors: Nigel
authors: N
authors: Heaton
authors: Kosh
authors: K
authors: Agarwal
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents