Ileal Pouch-anal Anastomosis in Primary Sclerosing Cholangitis-Inflammatory Bowel Disease (PSC-IBD)

Abstract

Objective: To compare the effect of liver transplantation (LT) on ileal pouch-anal anastomosis outcomes in patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD) Summary Background Data: Patients with PSC-IBD may require both IPAA for colitis and LT for PSC. Methods: Patients with PSC-IBD from out institutional pouch registry (1985 – 2022) were divided according to LT status and timing of LT (before and after IPAA) and their outcomes analyzed. Results: A total of 160 patients were included: 112 (70%) non-transplanted at last follow-up; 48 (30%) transplanted, of which 23 (14%) before IPAA and 25 (16%) after. Non-transplanted patients at IPAA had more laparoscopic procedures (37 [46%] vs 8 [18%], P=0.002) and less blood loss (median 250 cc vs 400 cc, P=0.006). Morbidity and mortality at 90-days were similar. Chronic pouchitis was higher in transplanted compared to non-transplanted patients (32 [67%] vs 51 [45.5%], P=0.03), but non-transplanted patients had a higher rate of chronic antibiotic refractory pouchitis. Overall survival was similar, but non-transplanted patients had more PSC-related deaths (12.5% vs 2%, P=0.002). Pouch survival at 10 years was 90% for non-transplanted patients and 100% for transplanted patients, log rank P=0.052. Timing of LT had no impact on chronic pouchitis, pouch failure, or overall survival. PSC recurrence was 6% at 10 years. For transplanted patients, graft survival was similar regardless of IPAA timing. Conclusions: In patients with PSC-IBD and IPAA, liver transplantation is linked to an increased pouchitis rate, but does not affect overall and pouch survival. Timing of LT does not influence short- and long-term pouch outcomes.