Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22442
Title: Activity of Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis Predicts Poorer Clinical Outcomes.
Authors: Peverelle, Matthew R;Paleri, Sarang;Hughes, Jed;De Cruz, Peter P;Gow, Paul J
Affiliation: Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
Issue Date: 16-Jan-2020
EDate: 2020-01-16
Citation: Inflammatory bowel diseases 2020; online first: 16 January
Abstract: The impact of inflammatory bowel disease (IBD) activity on long-term outcomes after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is unknown. We examined the impact of post-LT IBD activity on clinically significant outcomes. One hundred twelve patients undergoing LT for PSC from 2 centers were studied for a median of 7 years. Patients were divided into 3 groups according to their IBD activity after LT: no IBD, mild IBD, and moderate to severe IBD. Patients were classified as having moderate to severe IBD if they met at least 1 of 3 criteria: (i) Mayo 2 or 3 colitis or Simple Endoscopic Score-Crohn's Disease ≥7 on endoscopy; (ii) acute flare of IBD necessitating steroid rescue therapy; or (iii) post-LT colectomy for medically refractory IBD. Moderate to severe IBD at any time post-transplant was associated with a higher risk of Clostridium difficile infection (27% vs 8% mild IBD vs 8% no IBD; P = 0.02), colorectal cancer/high-grade dysplasia (21% vs 3% both groups; P = 0.004), post-LT colectomy (33% vs 3% vs 0%) and rPSC (64% vs 18% vs 20%; P < 0.001). Multivariate analysis revealed that moderate to severe IBD increased the risk of both rPSC (relative risk [RR], 8.80; 95% confidence interval [CI], 2.81-27.59; P < 0.001) and colorectal cancer/high-grade dysplasia (RR, 10.45; 95% CI, 3.55-22.74; P < 0.001). Moderate to severe IBD at any time post-LT is associated with a higher risk of rPSC and colorectal neoplasia compared with mild IBD and no IBD. Patients with no IBD and mild IBD have similar post-LT outcomes. Future prospective studies are needed to determine if more intensive treatment of moderate to severe IBD improves long-term outcomes in patients undergoing LT for PSC.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22442
DOI: 10.1093/ibd/izz325
ORCID: 0000-0003-0136-6699
0000-0002-3399-7236
PubMed URL: 31944235
Type: Journal Article
Subjects: inflammatory bowel disease
liver transplantation
primary sclerosing cholangitis
Appears in Collections:Journal articles

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