The Effect of Liver Transplantation for Primary Sclerosing Cholangitis on Disease Activity in Patients with Inflammatory Bowel Disease

Abstract

Purpose: The aims of this study were to examine the effects of immunosuppression following liver transplantation (LT) on inflammatory bowel disease (IBD) activity, and to identify predictors of IBD control post-LT, in subjects with who underwent LT specifically for primary sclerosing cholangitis (PSC). Methods: A retrospective analysis of all adult patients with a pre-LT diagnosis of IBD who underwent LT for PSC over a 15-year period was performed. The primary outcome was IBD activity based on symptomatology and endoscopic assessment, and secondary outcomes included recipient mortality and post-transplant development of colorectal cancer or small bowel lymphoma. Results: 105 subjects were transplanted for PSC, and 27 (26%) had a form of IBD diagnosed pre-LT and fulfilled inclusion criteria. Subjects were followed for a mean of 88.5 months. 14 subjects (52%) had stable IBD, 9 (33%) had worsening disease and 4 (15%) had clinical improvement after LT. 2 patients (7%) developed colorectal cancer and 1 patient (4%) developed small bowel lymphoma. The absence of additional maintenance therapy for IBD was found to be associated with good outcome for IBD control. The use of either infliximab or corticosteroids to control symptoms post-LT was found to be associated with poor outcome. Conclusion: Most patients with PSC/IBD have a stable course of IBD post-LT. The need for infliximab or additional corticosteroids after LT is associated with worse outcome.