Primary Sclerosing Cholangitis (PSC) has been associated with increased incidence of colorectal dysplasia and neoplasia in patients with Inflammatory Bowel Disease (IBD) compared to the patients with IBD without PSC. We aimed to assess the incidence of dysplasia in patients with PSC-IBD who underwent Liver Transplantation (LT) for PSC.Methods:
Between 1993 and 2015, 48 patients with IBD underwent liver transplantation for PSC at Henry Ford Health System. We retrospectively reviewed patient records to obtain various clinical and demographic data, both pre- and post-transplant. All the patients with PSC and IBD underwent annual surveillance colonoscopies pre and post-LT as the standard of care. We collected the data on dysplasia or neoplasia seen on surveillance biopsies done during the colonoscopy.Results:
Thirty-two males and 16 females with underlying IBD underwent liver transplantation for PSC. Forty (83%) of patients had Ulcerative Colitis, 4 had Crohn's disease, and 2 had indeterminate colitis. Thirty-six patients were either on 5-Aminosalicylic acid derivatives (5-ASA) or no treatment for IBD prior to LT. A total of 6 patients were found to have dysplasia of colon, 2 of which were diagnosed post LT. Four of these patients underwent colectomy and other 2 patients were followed with serial colon biopsies. Mean age at the first diagnosis of dysplasia was 49.5 + 11.6 years. Four out of the 6 patients had uncontrolled active IBD upon diagnosis of colonic dysplasia. None of the patients were treated with biologics for IBD. No mortality was seen amongst the patients. Mean duration of diagnosis of IBD to dysplasia was 31.1 + 13.4 years.Conclusions:
PSC in patients with IBD carries an increased risk of colonic dysplasia both before and after LT. No statistically significant difference was seen in the occurrence of dysplasia in the pre-LT versus post-LT setting. Annual surveillance colonoscopy should be used for early detection of dysplasia. Consideration of prophylactic colectomy in certain cases is worthwhile.