The following is a summary of “Ileal Pouch-anal Anastomosis in Primary Sclerosing Cholangitis-inflammatory Bowel Disease (PSC-IBD),” published in the December 2023 issue of Surgery by Maspero, et al.
For a study, researchers sought to find out how liver transplantation (LT) affects the results of ileal pouch-anal anastomosis (IPAA) in people who have primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD). People who have PSC-IBD might need both IPAA for colitis and LT for PSC. Patients with PSC-IBD from their institutional pouch registry (1985–2022) were split into groups based on their LT status and when they had their LT (before and after IPAA), and their results were looked at.
The study looked at 160 patients: 112 (70%) had not been transplanted at the last follow-up, while 48 (30%) had been transferred, with 23 (14%) happening before IPAA and 25 (16%) occurring after. At IPAA, patients who had not been transplanted had more laparoscopic procedures (37, or 46%) compared to 8 (18%), which is a significant difference (P=0.002), and they lost less blood (median 250 mL vs. 400 mL, P=0.006). At 90 days, the rates of illness and death were about the same. Patients who had transplants were more likely to have chronic pouchitis than patients who had not had transplants [32 (67%) vs. 51 (45.5%), P=0.03], but patients who had not had transplants were more likely to have chronic antibiotic-resistant pouchitis.
Overall mortality was about the same, but more patients who were not transferred died because of a PSC (12.5% vs. 2%, P=0.002). Pouch survival at 10 years was 90% for people who had not been transplanted and 100% for people who had been transplanted (log-rank P=0.052). When LT was done, it had no effect on chronic pouchitis, pouch failure, or life in general. PSC came back 6% of the time after 10 years. For implanted patients, graft mortality was the same no matter when IPAA was given.LT is linked to a higher rate of pouchitis in people with PSC-IBD and IPAA, but it doesn’t change total or pouch survival. When LT is done, it doesn’t change the short- or long-term results of pouches.
