Impact of Preexisting Inflammatory Bowel Disease on the Outcome of Liver Transplantation for Primary Sclerosing Cholangitis.

Autor: Irlès-Depé M; Service d'Hépatologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Roullet S; Service de Chirurgie Hépatobiliaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Neau-Cransac M; Service de Chirurgie Hépatobiliaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Dumortier J; Service de Gastro-Entérologie, Hôpital Haut-Lévêque, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Dharancy S; Service d'Anesthésie-Réanimation Uro-Vasculaire et Transplantation Rénale, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Houssel-Debry P; Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., Boillot O; Service de Gastro-Entérologie, Hôpital Haut-Lévêque, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Chiche L; Service d'Hépatologie, Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France., Laurent C; Service d'Hépatologie, Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France., Laharie D; Service d'Hépatologie, Hôpital Pont-Chaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France., De Lédinghen V; Service d'Hépatologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Jazyk: angličtina
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2020 Nov; Vol. 26 (11), pp. 1477-1491. Date of Electronic Publication: 2020 Oct 22.
DOI: 10.1002/lt.25838
Abstrakt: Approximately 80% of patients with primary sclerosing cholangitis (PSC) also have inflammatory bowel disease (IBD), and its effect on the outcomes of liver transplantation (LT) for PSC is unclear. We retrospectively collected data from adults who underwent LT for PSC from 1989 to January 2018 in 4 French LT centers. We compared the rates of patient and graft survivals and of complications after LT. Among 87 patients, 52 (60%) had preexisting IBD. Excluding those who died within the first 3 months, the 10-year patient survival and graft survival rates were 92.6% (95% confidence interval [CI], 84.3%-100%) and 77.1% (53.8%-85.3%), respectively, in the PSC with IBD (PSC-IBD) group and 97.1% (91.4%-100%; P = 0.44) and 83.2% (69.6%-96.9%; P = 0.43) in the isolated PSC group, respectively. Exposure to azathioprine after LT was significantly associated with mortality (odds ratio [OR], 15.55; 1.31-184.0; P = 0.03), whereas exposure to mycophenolate mofetil was associated with improved survival (OR, 0.17; 95% CI, 0.04-0.82; P = 0.03), possibly an era effect. The rate of recurrent PSC was 21% in the PSC-IBD group and 11% in the isolated PSC group (P = 0.24). Severe infections occurred in 125 per 1000 person-years in both groups. Exposure to mycophenolate mofetil was associated with a lower risk of infection (OR, 0.26; 95% CI, 0.08-0.85; P = 0.03). The presence of IBD was associated with cytomegalovirus (CMV) infection (OR, 3.24; 95% CI, 1.05-9.98; P = 0.04). IBD prior to LT for PSC may not affect patient or transplant survival but may increase the risk of CMV infection.
(Copyright © 2020 by the American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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