The fate of indefinite and low‐grade dysplasia in ulcerative colitis and primary sclerosing cholangitis colitis before and after liver transplantation

Summary 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. Aim 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.