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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

.

Ulcerative colitis in patients following liver transplantation for primary sclerosing cholangitis : XXX. kongres Slovenskej a Českej gastroenterologickej spoločnosti, XXVIII. slovenské a české endoskopické dni, XXXIII. hepatologické dni, Bratislava, 16.-1

Emeše Majorová, Jarmila Hornová, Libor Vítek, Jaromír Petrtýl

BACKGROUND

The clinical outcome of patients with ulcerative colitis (UC) after orthotopic liver transplantation (OLTx) for primary sclerosing cholangitis (PSC) is still unclear and published studies provide contrasting data.

AIM

To evaluate the course of UC after OLTx in our center (IKEM, Prague) including activity and possible dysplastic and/or neoplastic changes.

PATIENTS AND METHODS

We analyzed a cohort of 31 consecutive patients with PSC (mean age 39.7 ± 12.6 years) transplanted at our center between 1994 - 2003 (9.8 % of all OLTx). UC was diagnosed in 23 patients (74.2 %), no patients had history of Crohn´s disease. Colonoscopy was performed in all patients before OLTx and annually after OLTx with extent biopsies. No patients had undergone colectomy before transplant. The analysis includes 18 patients as 3 died (at 0,7,8 months) and 2 patients were lost from follow up in our center. Median follow up post OLTx was 3.4 years (range 1.1–9.3).

RESULTS

Despite the colitis was extent before OLTx, the clinical course of UC was mild or asymptomatic in 19/23 (83 %) patients, 12/18 (66.7 %) patients remained without relevant symptoms after OLT. Six patients (33.3 %) were suffering from clinically active disease confirmed by endoscopy after OLTx, 2 cases had an active pretransplant course of UC and 4 patients who were quiescent beforehand developed severe exacerbation of colitis after OLTx, in one case the CMV disease was detected as triggering factor. 3 patients flared-up after corticosteroid withdrawal. Symptoms of all patients with active colitis were well controlled with 5´-aminosalicylates and oral prednisone without any surgical intervention. Low-grade dysplasia (LGD) of colonic mucosa was found in 6/23 patients before and in 7/18 patients after OLTx (N.S.). In 2 patients with LGD before OLTx it has not been confirmed after OLTx. On the other hand LGD newly developed in 4 patients after OLTx. High-grade dysplasia or colorectal carcinoma were not detected.

CONCLUSION

The course of UC after OLT for PSC is frequently active despite the immunosuppressive treatment. The flare of disease developed also in patients with mild or asymptomatic course of UC in pretransplant period. No colectomy was necessary to control active UC after OLTx. We did not find increased frequency of dysplastic/neoplastic changes of colonic mucosa after OLTx.

This study is supported by grant IGA MH CR 7878/3

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