Recurrence of primary sclerosing cholangitis in patients with colectomy prior to liver transplantation
Teresa Bohatsch, Elias Tengström Datek, Hanna de la Croix, Maria Hermansson, Christina Villard, Helena TaflinAbstract
Introduction
Primary sclerosing cholangitis (PSC) is a chronic liver disease associated with inflammatory bowel disease (IBD). Liver transplantation (LT) is the only definitive treatment, but disease recurrence (rPSC) is common. The research field regarding the impact of colectomy on risk of rPSC after LT is highly conflicting.
Methods
This retrospective study include all PSC patients undergoing LT between 1986 and 2024 in Sweden. The association between rPSC and reconstruction method (Ileal pouch-anal anastomosis (IPAA), ileorectal anastomosis (IRA), continent ileostomy, end-ileostomy) was analysed using a multivariate Cox regression model.
Results
Among 584 PSC patients, the median age at LT was 44.0 years, 74% were male, and 84.9% had IBD. Among patients undergoing colectomy before LT, IPAA was the most common reconstruction method (37.6%, n = 38), followed by ileostomy (26.7%, n = 27), IRA (15.8%, n = 16), and continent ileostomy (13.9%, n = 14). In the subgroup analysis of 403 PSC–IBD patients, 23.8% (n = 96) developed rPSC at any time. In the multivariable Cox regression analysis, no association was found between reconstruction method prior to LT and risk of rPSC (P range 0.380–0.693). Significant confounders were sex (P = 0.018), date of LT (P = 0.003), transplant centre (P = 0.003), and recipient age (P = 0.004).
Discussion
In this nationwide cohort study, no association was found between risk of rPSC and reconstruction method following colectomy before LT. Partially in contrast to previous studies, our findings suggest reconstruction method alone is unlikely to be a major determinant of disease recurrence. Consequently, greater focus can be placed on other outcomes and patient preferences when restorative surgery is considered in PSC–IBD patients pretransplant.