Impact of ileal pouch-anal anastomosis on the surgical outcome of orthotopic liver transplantation for primary sclerosing cholangitis.
BACKGROUND
The definitive treatment for patients with primary sclerosing cholangitis (PSC) is orthotopic liver transplantation (OLT), while the surgical treatment of choice for UC is restorative protocolectomy with ileal pouch-anal anastomosis (IPAA). While studies to date show that OLT may impact the outcome of IPAA, the effect of IPAA on the surgical outcome of OLT is not known.


METHODS
All eligible patients (those with PSC and OLT) from our prospectively maintained OLT and Pouch Databases were included. Patient and OLT graft survivals along with surgical outcomes were assessed. Univariable and multivariable analyses were performed.


RESULTS
Seventy-nine patients with OLT for PSC were studied, including those with UC (PSC+OLT+UC, n=27) or without UC (PSC+OLT, n=30), and with UC and IPAA (PSC+OLT+UC+IPAA, n=22). In the PSC+OLT+UC group, 23 (85.2%) had UC before OLT and 4 (14.8%) had UC diagnosed after OLT. In the PSC+OLT+UC+IPAA group, 9 (40.9%) had IPAA-then-OLT and 13 (59.1%) had OLT-then-IPAA, while 21 (95.5%) had UC before OLT and 1 (4.5%) had UC diagnosed after OLT. Kaplan-Meier survival curve showed no statistical differences in patient and graft survivals between the 3 groups. In univariable analysis, there was no statistical difference for acute and chronic rejection, hepatic artery thrombosis, stricture, bile leak and acute and chronic renal failure for the 3 groups. In multivariable analysis, no factors were found to be associated with bacteremia or intra-abdominal abscess.


CONCLUSIONS
The presence of the IPAA in OLT for PSC patients appears not to have a negative impact on patient and graft survivals and post-operative complications.
Lerner College of Medicine, Department of Gastroenterology and Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Emmanuel C
EC
Obusez
Lei
L
Lian
Zhuo
Z
Shao
Udayakumar
U
Navaneethan
Robert
R
O'Shea
Ravi P
RP
Kiran
Bo
B
Shen
D000328:Adult; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome