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The Course of Ulcerative Colitis After Pediatric Liver Transplantation for Sclerosing Cholangitis

Marcin Osiecki1, Jarosław Kierkuś1, Joanna Pawłowska1

  • 1Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland.

Transplantation Proceedings
|November 9, 2020
PubMed

Insights

Liver transplantation for pediatric patients with primary sclerosing cholangitis (PSC) or autoimmune sclerosing cholangitis (ASC) did not worsen ulcerative colitis (UC) outcomes. Ulcerative colitis also did not impact patient or graft survival post-transplant.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Transplant Surgery

Background:

  • Primary sclerosing cholangitis (PSC) and autoimmune sclerosing cholangitis (ASC) are frequently associated with ulcerative colitis (UC).
  • The impact of PSC/ASC on UC course, especially in pediatric populations, requires further investigation.
  • Evidence regarding UC in pediatric patients undergoing liver transplantation for PSC/ASC is limited.

Purpose of the Study:

  • To evaluate the clinical course of ulcerative colitis (UC) in pediatric patients who received an orthotopic liver transplantation (OLT) due to primary sclerosing cholangitis (PSC) or autoimmune sclerosing cholangitis (ASC).
  • To determine if OLT for PSC/ASC affects UC progression or patient/graft survival.
  • To assess UC activity and outcomes in the post-transplant period.

Main Methods:

  • Retrospective review of pediatric patients with PSC/ASC and UC who underwent OLT.
  • Diagnosis of UC confirmed by clinical presentation, endoscopy, and histology.
  • Analysis of UC disease activity, treatment response, and post-transplant outcomes.

Main Results:

  • Seventeen pediatric patients (median age 16.8 years) with PSC/ASC and UC underwent OLT.
  • UC was diagnosed before OLT in 15 patients; 2 developed UC post-OLT.
  • Post-OLT, UC flares occurred in 4 patients, were successfully treated, and patients remained in remission. No colorectal cancer or colectomy was observed during follow-up (median 3.76 years).

Conclusions:

  • Orthotopic liver transplantation for PSC/ASC in pediatric patients does not appear to aggravate the course of ulcerative colitis.
  • Ulcerative colitis did not adversely affect patient or graft survival following OLT in this cohort.
  • Pediatric patients with UC undergoing OLT for PSC/ASC can achieve favorable long-term outcomes.
Abstract

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