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  • Title: [Clinical course of inflammatory bowel disease in patients transplanted for primary sclerosing cholangitis].
    Author: Villamil A, De Paula JA, Galdame O, Piccioni H, Ciardullo M, De Santibañes E, Gadano A.
    Journal: Acta Gastroenterol Latinoam; 2008 Dec; 38(4):252-9. PubMed ID: 19157380.
    Abstract:
    UNLABELLED: Primary sclerosing cholangitis is frequently associated with inflammatory bowel disease. OBJECTIVE: to evaluate the evolution of IBD in patients transplanted for PSC and the incidence of severe dysplasia/carcinoma. PATIENTS AND METHODS: we included 32 patients transplanted between 1988 and 2006 for PSC. Median follow-up: 8.7 years (1-20 y). All patients were evaluated pre-OLT with colonoscopy and multiple intestinal biopsies. Post-OLT surveillance colonoscopies were performed every 12 months. RESULTS: of 32 patients included, 26 had inflammatory bowel disease pre-OLT (ulcerative colitis 25, Crohn's disease 1). 12 patients had active intestinal disease pre-OLT and 2 patients had moderate dysplasia but were not surgically treated due to the severity of their liver disease. Among the 26 patients with IBD pre-OLT, 2 died in the postoperative period due to complications related to the transplantation procedure. Among the other 24 patients, 16 had a quiescent colonic disease post-OLT. Among them, 12 had quiescent disease pre-OLT and 4 showed improvement in their colonic symptoms after transplantation. Eight patients were symptomatic pre-OLT and had a transitory improvement in their symptoms post-OLT, with worsening of their intestinal disease by 5.7 +/- 2.8 months after transplantation. Three patients developed severe dysplasia or colonic cancer. CONCLUSIONS: over half of patients transplanted for PSC presented with quiescent intestinal disease. Yet, there was a group of patients that worsened their colonic symptoms and had a high incidence of dysplasia/carcinoma. It is necessary to maintain an adequate colonic surveillance even in the absence of colonic symptoms or active disease.
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