Outcome of Patients Undergoing Liver Transplantation for Primary Sclerosing Cholangitis

PURPOSE: The purpose of this study was to determine theoutcome of patients with inflammatory bowel disease whounderwent liver transplantation for primary sclerosingcholangitis. METHODS: All patients who underwent livertransplantation for primary sclerosing cholangitis at ourinstitution were identified. A review of patients hospitaland office charts was performed; all patients were thencontacted, and a detailed survey was administered by telephone.RESULTS: Sixty-nine patients were identified. Therewere 53 males (76.8 percent) and 16 females, with a meanage of 45.3 (± 13.3) years. Fifty-two (75.4 percent) of the 69patients had documented inflammatory bowel disease; ofthese, 40 had ulcerative colitis (76.9 percent), 11 hadCrohns disease, and 1 had indeterminate colitis. Thirty-onepatients (60 percent) were diagnosed with inflammatorybowel disease before primary sclerosing cholangitis, with amean interval to diagnosis of primary sclerosing cholangitisof 10.8 (± 10.3) years. Seven patients had both diagnosesmade at roughly the same time, and 14 patients initiallywere diagnosed with primary sclerosing cholangitis andsubsequently were found to have inflammatory bowel disease,with a mean interval of 5.2 (± 4.4) years; 5 (35.7percent) of those 14 patients were only diagnosed withinflammatory bowel disease after their liver transplant. Themean time from diagnosis of primary sclerosing cholangitisto liver transplantation was 6.1 (± 4.9) years. Since theirtransplant, 30.8 percent of patients rated their colitis asworse, 38.5 percent felt it was unchanged, and 30.8 percentfelt that their colitis was better controlled. Eight (15.4percent) of the 52 patients with inflammatory bowel diseasedenied having any knowledge of an increased risk ofcolorectal neoplasia. Four patients have required colectomyfor colorectal neoplasia after liver transplantation, at a meanof 4.7 years after transplantation. Of the patients with inflammatorybowel disease, 42 (80.1 percent) had at least 1posttransplant surveillance colonoscopy. Eight of the remainingten patients had a colectomy, leaving only twopatients (3.8 percent) who had not been surveyed. However,only 32 (61.5 percent) of the patients with inflammatorybowel disease have been on a surveillance regimen thatwould approximately conform to current screening recommendations.CONCLUSIONS: The activity of inflammatorybowel disease after transplantation is highly variable. Patientsappeared to lack knowledge of their increased risk forcolorectal neoplasia. Colorectal cancer is an uncommon butimportant complication in patients after liver transplantationfor primary sclerosing cholangitis, and ongoing surveillanceis required. Patients may require education to increasetheir awareness of the cancer risk and compliance withsurveillance.