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The effects of liver transplantation on the clinical course of colitis in ulcerative colitis patients with primary sclerosing cholangitis
Author(s) -
Navaneethan U.,
Choudhary M.,
Venkatesh P. G. K.,
Lashner B. A.,
Remzi F. H.,
Shen B.,
Kiran R. P.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05067.x
Subject(s) - medicine , ulcerative colitis , primary sclerosing cholangitis , gastroenterology , colectomy , liver transplantation , odds ratio , colitis , orthotopic liver transplantation , confidence interval , total colectomy , dysplasia , transplantation , disease
Summary Background The course of ulcerative colitis ( UC ) following orthotopic liver transplantation ( OLT ) for primary sclerosing cholangitis ( PSC ) is unclear. Aim To investigate the clinical course of UC , before and after OLT for PSC . Methods From a historical cohort of 86 patients with PSC ‐ UC who underwent OLT , 77 patients who were followed up at our institution both before and after OLT from 1985 to 2011 were included. Results Ulcerative colitis was diagnosed in 77 (97.5%) patients before OLT . Nineteen of 77 (24.7%) patients underwent colectomy before OLT . In the other 58 patients, the course of UC after OLT when compared to the last 5 years before OLT was quiescent in 48 patients (82.8%) while 9/58 (15.5%) of patients underwent colectomy post‐ OLT . There was a total of 97 colitis flares over a total of 621 years of follow‐up from PSC / UC diagnosis to OLT (0.156 flares per patient year) whereas post‐ OLT , there were 31 flares over a total of 511 years of post‐ OLT follow‐up (0.061 flares per patient year) ( P < 0.001). On univariable analysis, the number of UC flares [Odds ratio ( OR ) 1.52; 95% Confidence interval (1.02–2.27), P = 0.04] and dysplasia [ OR 47.00; 95% CI (6.48–340.66), P < 0.001] increased the risk of colectomy following OLT ; the use of corticosteroids [ OR 0.07; 95% CI (0.01–0.63), P = 0.008] and 5‐aminosalicylate [OR 0.18; 95% CI (0.04–0.83), P = 0.04] was protective. Conclusions Ulcerative colitis in the presence of primary sclerosing cholangitis remains quiescent, and may improve in most patients after orthotopic liver transplantation .