Survival Outcomes of Liver Transplant Patients With Primary Sclerosing Cholangitis and Inflammatory Bowel Disease

Abstract

Introduction: The effect of inflammatory bowel disease (IBD) on outcomes after liver transplantation (LT) for primary sclerosing cholangitis (PSC) has been inconclusive. It has been reported that patients with IBD who undergo LT for PSC may be at increased risk for adverse outcomes including re-LT. We evaluated the survival outcomes of patients who underwent LT for PSC with and without IBD. Methods: We retrospectively analyzed 2208 patients who underwent deceased donor LT at a large transplant center between January 2000 and December 2012. Adult PSC patients were included, while those with multiorgan transplantation or prior LTs were excluded. Kaplan-Meier survival analysis was performed. Results: 131 PSC patients underwent LT for PSC. Mean recipient age 49±14 years, 65% males, 74% Caucasians. Mean biologic MELD score at transplant 19 (range 6-40). Mean donor age 49±23. 89% had roux-en Y duct anastomosis. 11% (14) had cholangiocarcinoma and 2% (3) had HCC. 77 patients with PSC had IBD. 71% were male. Mean recipient age 50±14 years, mean MELD score 19.7±7. 88% (68) had ulcerative colitis (UC) and 10% (8) had Crohn's disease. 10% (8) had cholangiocarcinoma (CCA). The estimated PSC patient survival probabilities with and without IBD were 77% vs. 75% at 5-years. The estimated graft survival probabilities with and without IBD were 68% vs. 75% at 5-years. Kaplan-Meier patient and graft survival distributions were not statistically different among LT recipients for PSC with IBD compared to those without IBD (log-rank p=0.61 and p=0.11, respectively) (Figure 1).FigureConclusion: Liver transplant recipient and graft survival among PSC patients who have IBD are not significantly different from PSC patients who do not have IBD. IBD of PSC may not have a negative impact on survival as previously thought. PSC patients who are being evaluated for liver transplantation should have equal consideration and follow up following LT regardless of the IBD status.