Long-term Outcomes Following Colectomy and Liver Transplantation for Inflammatory Bowel Disease with Primary Sclerosing Cholangitis.

Autor:	Matar AJ; Emory University, Atlanta, Georgia., Falconer E; Emory University, Atlanta, Georgia., LaBella M; University of North Carolina, Chapel Hill, North Carolina., Kapadia MR; University of North Carolina, Chapel Hill, North Carolina., Justiniano CF; University of Cincinnati, Cincinnati, Ohio., Olortegui KS; University of Chicago, Chicago, Illinois., Steinhagen R; Icahn School of Medicine at Mount Sinai, New York, New York., Schultz K; Yale University, New Haven, Connecticut., Pratap A; Yale University, New Haven, Connecticut., Leeds I; Yale University, New Haven, Connecticut., Weaver L; University of Minnesota, Minneapolis, Minnesota., Gaertner W; University of Minnesota, Minneapolis, Minnesota., Finger EB; University of Minnesota, Minneapolis, Minnesota., Thompson M; University of Minnesota, Minneapolis, Minnesota., Fair L; Baylor University Medical Center, Dallas, Texas., Fichera A; Baylor University Medical Center, Dallas, Texas., Lovasik BP; Washington University in St. Louis, St. Louis, Missouri., Chapman WC; Washington University in St. Louis, St. Louis, Missouri., McGeoch CL; Emory University, Atlanta, Georgia., Camacho MC; Emory University, Atlanta, Georgia., Kazimi M; Emory University, Atlanta, Georgia., Kim SC; Emory University, Atlanta, Georgia., Shaffer VO; Emory University, Atlanta, Georgia., Srinivasan JK; Emory University, Atlanta, Georgia.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Sep 11. Date of Electronic Publication: 2024 Sep 11.
DOI:	10.1097/SLA.0000000000006533
Abstrakt:	Objective: To investigate the long-term outcomes of patients with combined primary sclerosing cholangitis/inflammatory bowel disease (PSC-IBD) undergoing both liver transplantation (LT) and total abdominal colectomy (TAC). Summary Background Data: The fraction of patients with PSC-IBD that require both LT and TAC is small, thereby limiting significant conclusions regarding long-term outcomes. Methods: Adult and pediatric patients from nine centers from the US IBD Surgery Collaborative who underwent staged LT and TAC for PSC-IBD were included. Long-term outcomes, including survival, were assessed. Results: Among 127 patients, 66 underwent TAC-before-LT, with a median time from TAC to LT of 7.9 yrs, while 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival post TAC was significantly worse in those undergoing LT-before-TAC (16.0 yrs vs. 42.6 yrs, P=0.007), while post LT survival was not impacted by the order of TAC and LT (21.6 yrs vs. 22.0 yrs, P=0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC (rPSC) (P=0.02) and biliary complications (0.09) compared to those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis (IPAA) did not impact post-LT or post-TAC outcomes. Conclusions: Long term survival in PSC-IBD was contingent upon progression to LT and was not impacted by the need for TAC. PSC-IBD patients undergoing TAC for medically refractory disease had a higher incidence of rPSC and biliary complications. The use of IPAA in PSC-IBD was a viable alternative to end ileostomy. Competing Interests: Conflict of Interest Statement: All authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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