1. Ileal pouch-anal anastomosis and end ileostomy result in equivalent graft survival following liver transplantation for inflammatory bowel disease-primary sclerosing cholangitis.
- Author
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Schabl L, Holubar SD, Maspero M, Steele SR, and Hull T
- Subjects
- Humans, Female, Male, Middle Aged, Adult, Retrospective Studies, Colitis, Ulcerative surgery, Treatment Outcome, Colonic Pouches adverse effects, Inflammatory Bowel Diseases surgery, Inflammatory Bowel Diseases complications, Reoperation statistics & numerical data, Reoperation methods, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Liver Transplantation adverse effects, Liver Transplantation methods, Cholangitis, Sclerosing surgery, Cholangitis, Sclerosing mortality, Cholangitis, Sclerosing complications, Ileostomy adverse effects, Ileostomy methods, Graft Survival, Proctocolectomy, Restorative methods, Proctocolectomy, Restorative adverse effects, Postoperative Complications etiology, Postoperative Complications epidemiology
- Abstract
Introduction: Patients with inflammatory bowel disease and primary sclerosing cholangitis may require both liver transplantation and colectomy. There are concerns about increased rates of hepatic artery thrombosis, biliary strictures, and hepatic graft loss in patients with ileal pouch-anal anastomosis compared to those with end ileostomy. We hypothesized that graft survival was not negatively affected by ileal pouch-anal anastomosis compared to end ileostomy., Materials and Methods: A tertiary center's database was searched for patients meeting the criteria of liver transplantation because of primary sclerosing cholangitis and total proctocolectomy with ileal pouch-anal anastomosis or end ileostomy because of ulcerative colitis. Primary endpoints were hepatic graft survival and post-transplant complications., Results: Fifty-five patients met the inclusion criteria between January 1990 and December 2022. Of these, 46 (84%) underwent ileal pouch-anal anastomosis, and 9 (16%) underwent end ileostomy. The average age at total proctocolectomy (41.5 vs. 49.1 years; p = 0.12) and sex distribution (female: 26.1% vs. 22.2%; p = 0.99) were comparable. The rates of re-transplantation (21.7% vs. 22.2%; p = 0.99), hepatic artery thrombosis (10.8% vs. 0; p = 0.58), acute rejection (32.6% vs. 44.4%; p = 0.7), chronic rejection (4.3% vs. 11.1%; p = 0.42), recurrence of primary sclerosing cholangitis (23.9% vs. 22.2%; p = 0.99), and biliary strictures (19.6% vs. 33.3%; p = 0.36) were similar between the ileal pouch-anal anastomosis and end ileostomy groups, respectively. None of the end ileostomy patients developed parastomal varices. The log-rank tests for graft (p = 0.97), recipient (p = 0.3), and combined graft/recipient survival (p = 0.73) were similar., Conclusion: Ileal pouch-anal anastomosis did not negatively affect graft, recipient, and combined graft/recipient survival, or the long-term complications, compared to end ileostomy., (© 2024. Springer Nature Switzerland AG.)
- Published
- 2024
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