• Abraham J Matar, Elissa Falconer, Michelle LaBella, Muneera R Kapadia, Carla F Justiniano, Kinga Skowron Olortegui, Randolph Steinhagen, Kurt Schultz, Anurag Pratap, Ira Leeds, Lauren Weaver, Wolfgang Gaertner, Erik B Finger, Mary Thompson, Lucas Fair, Alessandro Fichera, Brendan P Lovasik, William C Chapman, Catherine Lb McGeoch, Mary Catherine Camacho, Marwan Kazimi, Steven C Kim, Virginia O Shaffer, and Jahnavi K Srinivasan.
• Emory University, Atlanta, Georgia.
• Ann. Surg. 2024 Sep 11.

ObjectiveTo 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 DataThe fraction of patients with PSC-IBD that require both LT and TAC is small, thereby limiting significant conclusions regarding long-term outcomes.MethodsAdult 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.ResultsAmong 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.ConclusionsLong 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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

14 keywords...

hide…