title: Management of ulcerative colitis pre- and post-liver transplant for primary sclerosing cholangitis: two case reports and review of literature.
abstract: BACKGROUND
  Management of ulcerative colitis (UC) pre- and post-liver transplant for primary sclerosing cholangitis (PSC) can be challenging and complex. There are no formal guidelines, but there is a plethora of data regarding the use of medical and surgical treatment options, mainly from case series, retrospective data, and experience from transplant centers.
  
  
  CONCLUSIONS
  We present two cases of UC-PSC with variable severity of liver disease and discuss the available data on the management of UC pre- and post-liver transplant. A PubMed search was conducted using various keyword combinations looking for studies involving patients with UC-PSC pre- and post-liver transplant. We reviewed and summarized the available literature on the course of UC in patients with PSC-related cirrhosis pre- and post-transplant and risk of colorectal neoplasia post-transplant. Finally, we summarize the available data on the medical and surgical management of UC pre- and post-liver transplant and the effect of transplant on pouchitis. Current literature supports the use of medical therapies, including immunomodulators and biologic agents, following liver transplant. There is also literature supporting surgical management including total colectomy. A multidisciplinary, patient-centered approach is important when managing UC pre- and post-liver transplantation.
authors.affiliation: Division of Gastroenterology, Allegheny General Hospital, Allegheny Health Network, 1301 Federal North Street, Suite 301, Pittsburgh, PA, 15212, USA.
authors.forename: Kiranpreet
authors.initials: K
authors.lastname: Khosa
authors.forename: Kofi
authors.initials: K
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000453:epidemiology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D000069285:Infliximab; D016031:Liver Transplantation; D012307:Risk Factors
chemical_list: D000636:Aminosalicylic Acids; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069285:Infliximab