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

Abraham J Matar; Elissa Falconer; Michelle LaBella; Muneera R Kapadia; Carla F Justiniano; Kinga Skowron Olortegui; Randolph Steinhagen; Kurt Schultz; Anurag Pratap; Ira Leeds; Lauren Weaver; Wolfgang Gaertner; Erik B Finger; Mary Thompson; Lucas Fair; Alessandro Fichera; Brendan P Lovasik; William C Chapman; Catherine Lb McGeoch; Mary Catherine Camacho; Marwan Kazimi; Steven C Kim; Virginia O Shaffer; Jahnavi K Srinivasan

doi:10.1097/SLA.0000000000006533

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

Ann Surg. 2024 Sep 11. doi: 10.1097/SLA.0000000000006533. Online ahead of print.

Authors

Abraham J Matar¹, Elissa Falconer¹, Michelle LaBella², Muneera R Kapadia², Carla F Justiniano³, Kinga Skowron Olortegui⁴, Randolph Steinhagen⁵, Kurt Schultz⁶, Anurag Pratap⁶, Ira Leeds⁶, Lauren Weaver⁷, Wolfgang Gaertner⁷, Erik B Finger⁷, Mary Thompson⁷, Lucas Fair⁸, Alessandro Fichera⁸, Brendan P Lovasik⁹, William C Chapman⁹, Catherine Lb McGeoch¹, Mary Catherine Camacho¹, Marwan Kazimi¹, Steven C Kim¹, Virginia O Shaffer¹, Jahnavi K Srinivasan¹

Affiliations

¹ Emory University, Atlanta, Georgia.
² University of North Carolina, Chapel Hill, North Carolina.
³ University of Cincinnati, Cincinnati, Ohio.
⁴ University of Chicago, Chicago, Illinois.
⁵ Icahn School of Medicine at Mount Sinai, New York, New York.
⁶ Yale University, New Haven, Connecticut.
⁷ University of Minnesota, Minneapolis, Minnesota.
⁸ Baylor University Medical Center, Dallas, Texas.
⁹ Washington University in St. Louis, St. Louis, Missouri.

PMID: 39258375
DOI: 10.1097/SLA.0000000000006533

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).

Summary background data: 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 nine centers from the US 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 yrs, while 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival post TAC was significantly worse in those undergoing LT-before-TAC (16.0 yrs vs. 42.6 yrs, P=0.007), while post LT survival was not impacted by the order of TAC and LT (21.6 yrs vs. 22.0 yrs, P=0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC (rPSC) (P=0.02) and biliary complications (0.09) compared to those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis (IPAA) 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. PSC-IBD patients undergoing TAC for medically refractory disease had a higher incidence of rPSC and biliary complications. The use of IPAA in PSC-IBD was a viable alternative to end ileostomy.