Colorectal dysplasia and malignancy outcomes in primary sclerosing cholangitis and inflammatory bowel disease requiring liver transplantation and colectomy: A multicenter study.

Abstract

Literature guiding management of patients with primary sclerosing cholangitis and inflammatory bowel disease undergoing liver transplantation for primary sclerosing cholangitis and total abdominal colectomy for dysplasia or malignancy is limited. This study describes patterns of colorectal dysplasia, malignancy, and ileal pouch anal anastomosis outcomes for these patients. Electronic health records from 9 centers were retrospectively reviewed. Adult patients who underwent liver transplantation for primary sclerosing cholangitis and total abdominal colectomy for inflammatory bowel disease with dysplasia or malignancy were eligible. Descriptive statistics were analyzed between 2 groups: total abdominal colectomy before liver transplantation (total abdominal colectomy first) and liver transplantation before total abdominal colectomy (liver transplantation first). Of 50 eligible patients, 30 underwent total abdominal colectomy for dysplasia and 20 for malignancy. Between the total abdominal colectomy first and liver transplantation first groups, there were no significant differences in malignancy as the indication for total abdominal colectomy (11 [50.0%] vs 9 [33.3%]; P= .26), T3+ disease (5 [50.0%] vs 2 [25.0%]; P= .37), or distant metastasis at the time of diagnosis (none). Nodal involvement was higher in the liver transplantation first group (5 [50.0%] vs 0 [0.0%]; P = .04). Colorectal cancer recurrence and 5-year overall survival were similar between groups (2 [18.2%] vs 2 [22.2%] and 7 [87.5%] vs 6 [75.0%]; all P= 1.0, respectively). Kaplan-Meier survival analysis showed no significant difference between the groups (P = .4). Both groups had a 54.5% rate of pouchitis. There was only 1 pouch failure. Despite more advanced disease at presentation for liver transplantation first patients, 5-year overall survival was comparable to total abdominal colectomy first patients and the general literature. Patients with ileal pouch anal anastomosis had similar rates of pouchitis to prior studies and low pouch failure.