A frequent dilemma faced in the inflammatory bowel disease (IBD) clinic is how to best treat a patient with a previous cancer diagnosis. The changing demographics of our patient population will make this quandary more common. Previous guidance has emphasised the importance of lengthy postcancer drug holidays and cautious use of IBD therapies. However, accumulating evidence suggests this approach may be unnecessarily conservative. This review considers recent evidence on the safety of IBD drugs, cancer and recurrent cancer risk in patients with IBD and provides a framework for shared decision making involving patient, gastroenterologist and oncologist.
30 days. European data are sparse. We aimed to define the readmission rate in Scotland and identify reasons and predictors for readmission. Methods Patients undergoing primary transplant with cirrhosis between January 2009 and December 2018 were included (n=639). Data were collected on patient and disease demographics and blood results at transplant and discharge. Differences between those readmitted and not readmitted at 30 days were assessed using Chi-squared or Mann-Whitney U tests. Survival was assessed using Kaplan-Meier analysis. Cox proportional hazards were used to predict readmissions. Results Patients were predominantly male (n=410; 64.2%) with a median age of 58.9 years (IQR 51.8-64.1) at transplant. The commonest aetiologies were alcohol-related liver disease (n=226; 35.4%), chronic viral hepatitis (n=111; 17.4%) and non-alcoholic fatty liver disease (n=104; 16.4%). 208 patients (32.6%) had a hepatocellular carcinoma. Patients had a median UKELD of 55 (52-59) and a median length of stay of 13 days (10-18). One year mortality was 4.1% (n=26).Readmission rates were: 30 days, 19.4% (n=124); 90 days, 30.6% (n=194); 1 year, 46.9% (n=300). Demographics and blood results were similar between those readmitted at 30 days and those not, although significant differences were haemoglobin (g/dL) at transplant (readmitted vs not readmitted) (105 vs. 111; p=0.02), urea (mmol/L) at discharge (7.5 vs 6.3; p=0.009), and creatinine (mmol/L) at discharge (80 vs 73; p=0.007).Readmission within 30 days post LT conferred a significantly higher 1-year mortality (10 (8.1%) vs. 16 (3.1%) (p=0.012) (OR=2.74; (95% CI 1.210-6.186)); and represented a significant survival disadvantage at 1 year in a Kaplan-Meier analysis (readmitted within 30 days: mean survival 348 days (95% CI 337-359) vs not readmitted within 30 days: mean survival 361 days (95% CI 358-363). Log rank p=0.01).The main reasons for admissions were deranged LFTs (34%; n=42), AKI (22%; n=27), and infection (18%; n=22).Significant differences on multivariate analysis were found for haemoglobin at transplant (HR=0.988 (95% CI 0.979-0.996); p=0.005) and creatinine at discharge (HR=1.006 (95% CI 1.003-1.010); p=0.001). Discussion In Scotland, readmission rates following LT were lower than in previously published, American, data. Haemoglobin and creatinine were predictors of readmission.Patients readmitted within 30 days of LT were more than twice as likely to die within 1 year.The commonest reasons for readmission were deranged LFTs, AKI and infection.
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