Transplantation · 2026
Clinical Outcomes of Patients With Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis: A Systematic Review and Meta-analysis.
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Zhou Jiangrong, Sneek Dennis, Hansen Bettina, den Hoed Caroline M, de Jong Marin, van der Meer Adriaan J, Pan Qiuwei, Li Pengfei, de Vries Annemarie C
Аннотация
BACKGROUND: The clinical course of primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) after liver transplantation (LTx) varies significantly across studies. This meta-analysis aims to provide a comprehensive estimation of incidence rates (IR) for IBD-related outcomes and PSC recurrence.
METHODS: Online databases (January 2000-June 2025) were searched for studies on PSC patients with or without IBD at LTx. Studies reporting posttransplant outcomes of interest were included. The pooled IR were calculated with the "meta" package (R Studio [V.4.3.2]) using a random effects model.
RESULTS: A total of 34 studies (3828 patients; 67% with IBD at transplantation) were included. The IR of preexiting IBD exacerbation was 36.1 per 1000 person-years (95% confidence intervals [CI], 23.0-56.5). Medically refractory IBD requiring colectomy occurred at an IR of 12.4 per 1000 person-years (95% CI, 8.9-17.4). The IRs of colorectal neoplasia and advanced neoplasia were 10.3 (95% CI, 6.4-16.7) and 7.7 (95% CI, 5.6-10.7) per 1000 person-years, respectively. Among posttransplant PSC-only patients, the IR of newly diagnosed IBD was 20.0 (95% CI, 12.0-33.4). PSC recurrence occurred more frequently in PSC-IBD patients (31.9; 95% CI, 25.0-40.5) than in PSC-only patients (21.4; 95% CI, 11.3-40.6), corresponding to an incidence rate ratio of 2.16 (95% CI, 1.72-2.72; P < 0.001).
CONCLUSIONS: After LTx for PSC, patients remain at substantial risk of colorectal neoplasia and de novo IBD. PSC-IBD is associated with a higher risk of disease recurrence. These findings support continued endoscopic surveillance and close monitoring of IBD activity.
METHODS: Online databases (January 2000-June 2025) were searched for studies on PSC patients with or without IBD at LTx. Studies reporting posttransplant outcomes of interest were included. The pooled IR were calculated with the "meta" package (R Studio [V.4.3.2]) using a random effects model.
RESULTS: A total of 34 studies (3828 patients; 67% with IBD at transplantation) were included. The IR of preexiting IBD exacerbation was 36.1 per 1000 person-years (95% confidence intervals [CI], 23.0-56.5). Medically refractory IBD requiring colectomy occurred at an IR of 12.4 per 1000 person-years (95% CI, 8.9-17.4). The IRs of colorectal neoplasia and advanced neoplasia were 10.3 (95% CI, 6.4-16.7) and 7.7 (95% CI, 5.6-10.7) per 1000 person-years, respectively. Among posttransplant PSC-only patients, the IR of newly diagnosed IBD was 20.0 (95% CI, 12.0-33.4). PSC recurrence occurred more frequently in PSC-IBD patients (31.9; 95% CI, 25.0-40.5) than in PSC-only patients (21.4; 95% CI, 11.3-40.6), corresponding to an incidence rate ratio of 2.16 (95% CI, 1.72-2.72; P < 0.001).
CONCLUSIONS: After LTx for PSC, patients remain at substantial risk of colorectal neoplasia and de novo IBD. PSC-IBD is associated with a higher risk of disease recurrence. These findings support continued endoscopic surveillance and close monitoring of IBD activity.