Long-term Outcomes Following Colectomy and Liver Transplantation for Inflammatory Bowel Disease With Primary Sclerosing Cholangitis

Abstract

Objective: To investigate the long-term outcomes of patients with combined primary sclerosing cholangitis/inflammatory bowel disease (PSC-IBD) undergoing both liver transplantation (LT) and total abdominal colectomy (TAC).

Background: The fraction of patients with PSC-IBD that require both LT and TAC is small, thereby limiting significant conclusions regarding long-term outcomes.

Methods: Adult and pediatric patients from 9 centers from the U.S. IBD Surgery Collaborative who underwent staged LT and TAC for PSC-IBD were included. Long-term outcomes, including survival, were assessed.

Results: Among 127 patients, 66 underwent TAC-before-LT, with a median time from TAC to LT of 7.9 years, whereas 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival after TAC was significantly worse in those undergoing LT-before-TAC (16.0 vs 42.6 years, P = 0.007), whereas post-LT survival was not impacted by the order of TAC and LT (21.6 vs 22.0 years, P = 0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC ( P = 0.02) and biliary complications (0.09) compared with those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis did not impact post-LT or post-TAC outcomes.

Conclusions: Long-term survival in PSC-IBD was contingent upon progression to LT and was not impacted by the need for TAC. Patients with PSC-IBD undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC and biliary complications. The use of ileal-pouch anal anastomosis in PSC-IBD was a viable alternative to end ileostomy.

Keywords: colectomy; inflammatory bowel disease; liver transplantation; primary sclerosing cholangitis.