PTU-060 Primary sclerosing cholangitis post liver transplantation—the impact of inflammatory bowel disease

Abstract

<h3>Introduction</h3> An association between PSC and IBD is well recognised. Patients with PSC are increasingly and successfully treated by liver transplantation (LT), but the post LT course of IBD remains ill-defined. <h3>Methods</h3> A retrospective cohort study was performed to define the post transplant course of all adult (&gt;18 years) patients who had undergone LT for PSC at Kings College Hospital (Oct 1990-Aug 2009). Comparison populations of IBD/PSC and PSC were analysed. <h3>Results</h3> 110 patients (72% male) with PSC underwent LT (mean age 47±11). 74 (67%) patients had concurrent IBD (IBD/PSC) and 36 had PSC alone (PSC). In the IBD/PSC group 67 pts (91%) had UC (&gt;90% pan-colonic disease). A further six patients (5%) were diagnosed with UC post LT. In the IBD/PSC group, mean duration of IBD was longer compared to the duration of PSC pre-LT (104.7±136.7 vs 25±40.3, p=0.0001). 13% had undergone pan-proctocolectomy and 18% were not on any medications. Patient survival post LT was similar at 1 and 5 years (91% and 87% PSC vs 96% and 88% IBD/PSC). Graft survival was also similar between both groups although an increased incidence of HAT (six cases) was noted in the IBD/PSC group. Thrombotic events were increased in IBD/PSC (12 cases vs 1 case). 31 patients had a flare of IBD (mean time to flare 34 months±28). IBD free survival at 5 years was 50% in the IBD/PSC group. Mean time (months) to recurrence of PSC was similar between the two groups (65±36 vs 65±8). On univariate analysis predictors of graft survival included active colitis pre-LT (OR 16, 95% CI 3 to 94, p=0.02), immunosuppression (OR 6, 1.3 to 29, p=0.02), HAT (OR 6, 1.6 to 24, p=0.007) and pre-LT colectomy conferred a graft survival benefit (OR 5.6, 1.8 to 17.8, p=0.003). Smoking pre-LT was a predictor of recurrence of IBD post LT (OR 14, 2 to 75, p=0.003). Only 54 patients in the IBD/PSC group (72%) had documented evidence of annual colonoscopy post LT. 36% of patients (8/75) required colectomy in the IBD/PSC group; six for severe disease and two for de-novo neoplasia. A higher rate of neoplasia was seen in the IBD/PSC group (70% vs 30%). Duration of PSC pre-LT was predictive of rPSC (OR 1.03, 1.01 to 1.05, p=0.002). Multivariate analysis: only active colitis was a predictor of graft survival (OR 14, 2 to 100, p=0.01). <h3>Conclusion</h3> Patient survival post LT for PSC with or without IBD appeared similar. Patients with IBD/PSC are at increased risk of thrombotic events compared to PSC patients post-LT. Optimising management of IBD, including consideration of colectomy, may improve outcomes post LT.