title: The fate of indefinite and low-grade dysplasia in ulcerative colitis and primary sclerosing cholangitis colitis before and after liver transplantation.
abstract: BACKGROUND
  Patients with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) are at an increased risk of colorectal neoplasia, but it is unknown if liver transplantation (LT) alters neoplasia progression.
  
  
  OBJECTIVE
  To examine the natural history of indefinite dysplasia (IND) and low-grade dysplasia (LGD) that develop in patients with PSC-UC with and without LT.
  
  
  METHODS
  We performed a retrospective review of patients with PSC and UC evaluated at our institution between 1993 and 2011 who were diagnosed with IND or LGD before or after LT for PSC. The primary end point was neoplasia progression or persistent LGD.
  
  
  RESULTS
  Ninety-six patients (non-LT n = 63, LT n = 33) were examined. For the IND group, multifocal lesions were significantly associated with time to neoplasia progression [hazard ratio (HR), 3.5; 95% confidence interval (CI), 1.3-9.7], while 5-aminosalicylate (5-ASA) use was protective (HR, 0.2; 95% CI, 0.1-0.6). For patients with LGD, multifocal lesions were significantly associated with the primary end point (HR, 7.1; 95% CI, 1.7-28.3), while LT was protective (HR, 0.3; 95% CI, 0.1-0.9).
  
  
  CONCLUSIONS
  In PSC-UC patients with IND, 5-ASA use was associated with a decreased the risk of neoplasia progression, regardless of transplant status. In contrast, multifocal IND and LGD were associated with neoplasia progression or persistent LGD. Patients who developed LGD following LT for PSC were less likely to have progressive neoplasia or persistent LGD, compared with those who had not been transplanted.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Eaton
authors.forename: T C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: M
authors.initials: M
authors.lastname: Imam
authors.forename: D S
authors.initials: DS
authors.lastname: Pardi
authors.forename: E V
authors.initials: EV
authors.lastname: Loftus
authors.forename: V L
authors.initials: VL
authors.lastname: Owens
authors.forename: J A
authors.initials: JA
authors.lastname: Talwalkar
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine