Liver Transplantation, IBD Clinical Course, Is There a Link? A Systematic Review and Meta-Analysis Protocol

Abstract

BackgroundPrimary sclerosing cholangitis (PSC) is an uncommon chronic and progressive cholestatic liver disease. There is a robust association between PSC and Inflammatory Bowel Disease (IBD), usually Ulcerative Colitis (UC). According to the review of literature, the incidence of de novo IBD after solid organ transplantation (SOT) is found to be higher than general population. Considering lacking of any systematic review and pursuing debate on the clinical course and risk factors of IBD activity after Liver Transplantation (LT), the present study will be performed with a focus investigation on the correlation of IBD clinical course with liver transplantation. MethodsIn this systematic review, the electronic databases including PubMed/MEDLINE, Scopus, WoS (Clarivate Analytics), Embase (Embase.com), and ProQuest will be searched. Our search strategy (i.e. The eligibility criteria) covers prospective and retrospective observational studies that evaluated the clinical course of ulcerative colitis or/and Crohn’s disease after liver transplantation with no language limitation published between 1970.01.01 and 2020.03.30. The selection phase, data extraction and quality assessment will be independently implemented by two authors. In case of any disagreement between the authors, the issue will be resolved by consensus; if not resolved, the opinion of a third expert will be asked. We will use one of the following two models: Random Effect Model or Fixed Effect Model according to the severity of methodological heterogeneity and forest plot will present the combination of data obtained from all finally included studies, to show the separated and combined frequency and their corresponding 95% CIs. Statistical heterogeneity will be evaluated by the Q-statistic test and I2 statistics. Funnel plot for assessing the potential reporting bias, Begg's and Egger's tests for meaningful results of the publication bias, and the Fill & Trim method for corrected publication bias will be used. DiscussionThis systematic review and meta-analysis study will clarify the correlation of IBD clinical course with liver transplantation. Because of the importance of inflammatory bowel disease, if the future study reveals consistent results, it will be clinically beneficial for physicians and other health care professionals to better manage inflammatory bowel disease after liver transplantation.Systematic review registrationPROSPERO, CRD42020179412.