Annals of surgery · 2024
Long-term Outcomes Following Colectomy and Liver Transplantation for Inflammatory Bowel Disease With Primary Sclerosing Cholangitis.
СтатьяМногоцентровое исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Matar Abraham J, Falconer Elissa, LaBella Michelle, Kapadia Muneera R, Justiniano Carla F, Olortegui Kinga Skowron, Steinhagen Randolph, Schultz Kurt, Pratap Anurag, Leeds Ira, Weaver Lauren, Gaertner Wolfgang, Finger Erik B, Thompson Mary, Fair Lucas, Fichera Alessandro, Lovasik Brendan P, Chapman William C, McGeoch Catherine L B, Camacho Mary Catherine, Kazimi Marwan, Kim Steven C, Shaffer Virginia O, Srinivasan Jahnavi K
Аннотация
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).
BACKGROUND: 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 9 centers from the U.S. 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 years, whereas 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival after TAC was significantly worse in those undergoing LT-before-TAC (16.0 vs 42.6 years, P = 0.007), whereas post-LT survival was not impacted by the order of TAC and LT (21.6 vs 22.0 years, P = 0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC ( P = 0.02) and biliary complications (0.09) compared with those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis 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. Patients with PSC-IBD undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC and biliary complications. The use of ileal-pouch anal anastomosis in PSC-IBD was a viable alternative to end ileostomy.
BACKGROUND: 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 9 centers from the U.S. 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 years, whereas 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival after TAC was significantly worse in those undergoing LT-before-TAC (16.0 vs 42.6 years, P = 0.007), whereas post-LT survival was not impacted by the order of TAC and LT (21.6 vs 22.0 years, P = 0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC ( P = 0.02) and biliary complications (0.09) compared with those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis 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. Patients with PSC-IBD undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC and biliary complications. The use of ileal-pouch anal anastomosis in PSC-IBD was a viable alternative to end ileostomy.