Impact of ileal pouch-anal anastomosis on the surgical outcome of orthotopic liver transplantation for primary sclerosing cholangitis

Abstract

The presence of the IPAA in OLT for PSC patients appears not to have a negative impact on patient and graft survivals and post-operative complications.

The impact of ileal pouch‐anal anastomosis on graft survival following liver transplantation for primary sclerosing cholangitis

“…An early study from the Mayo clinic indicated a 10‐year graft loss rate of 12.5% for transplanted PSC patients with an IPAA . The Cleveland Clinic have also published their experience; and in a total cohort of 79 transplanted PSC patients, they also found an increased frequency of hepatic artery thrombosis (27% in the IPAA group vs 18% in the no colectomy group) although surprisingly none went onto be re‐transplanted, and a comparative outcomes’ analysis against a control ileostomy group was not presented . By contrast, ours is also the first study to robustly determine the impact of colectomy status and type in a time‐dependent outcomes’ analysis for patients with PSC/UC and show improved graft survival when patients elect to retain an ileostomy.…”

“…In a Nationwide study from Sweden, the pouch failure rates following restorative proctocolectomy were not significantly different between patients with UC alone vs PSC/UC, although other investigators have reported consistently poorer nocturnal pouch function and worse quality of life scores in the latter group, in addition to high rates of recurrent pouchitis, pouch mucosal atrophy and dysplastic change . With respect to the post‐liver transplant setting, 58%‐62% of patients may develop exacerbating features of acute pouchitis . IRA may also not be favoured given the increased risk of rectal cancer associated with PSC specifically …”

“…[22][23][24] With respect to the post-liver transplant setting, 58%-62% of patients may develop exacerbating features of acute pouchitis. [25][26][27] IRA may also not be favoured given the increased risk of rectal cancer associated with PSC specifically. 28,29 While the frequency of pouch-related complications is well documented in the PSC literature, the impact of IPAA on graft survival following liver transplantation is ill defined.…”

Hepatobiliary disorders and complications of inflammatory bowel disease

“…IPAA does not appear to affect the disease course of PSC and the latter appears to follow an independent disease course in spite of proctocolectomy 93–96 . The presence of UC with or without IPAA may also increase the risk for intra‐abdominal abscess in patients undergoing OLT for PSC 97 . In a study by our group evaluating the postoperative infectious complications and other surgical outcomes of OLT for PSC in UC patients, bacteremia and intra‐abdominal abscess were more common in the PSC + OLT + UC + IPAA and PSC + OLT + UC groups than that in the PSC + OLT group.…”

Hepatobiliary manifestations of ulcerative colitis: an example of gut-liver crosstalk

“…The presence of the IPAA in OLT for PSC patients appears not to have a negative impact on patient- and graft survivals and post-operative complications in liver transplants [72]. …”