PTU-060 Primary sclerosing cholangitis post liver transplantation—the impact of inflammatory bowel disease

Introduction An association between PSC and IBD is well recognised. Patients with PSC are increasingly and successfully treated by liver transplantation (LT), but the post LT course of IBD remains ill-defined. Methods A retrospective cohort study was performed to define the post transplant course of all adult (>18 years) patients who had undergone LT for PSC at Kings College Hospital (Oct 1990-Aug 2009). Comparison populations of IBD/PSC and PSC were analysed. Results 110 patients (72% male) with PSC underwent LT (mean age 47±11). 74 (67%) patients had concurrent IBD (IBD/PSC) and 36 had PSC alone (PSC). In the IBD/PSC group 67 pts (91%) had UC (>90% pan-colonic disease). A further six patients (5%) were diagnosed with UC post LT. In the IBD/PSC group, mean duration of IBD was longer compared to the duration of PSC pre-LT (104.7±136.7 vs 25±40.3, p=0.0001). 13% had undergone pan-proctocolectomy and 18% were not on any medications. Patient survival post LT was similar at 1 and 5 years (91% and 87% PSC vs 96% and 88% IBD/PSC). Graft survival was also similar between both groups although an increased incidence of HAT (six cases) was noted in the IBD/PSC group. Thrombotic events were increased in IBD/PSC (12 cases vs 1 case). 31 patients had a flare of IBD (mean time to flare 34 months±28). IBD free survival at 5 years was 50% in the IBD/PSC group. Mean time (months) to recurrence of PSC was similar between the two groups (65±36 vs 65±8). On univariate analysis predictors of graft survival included active colitis pre-LT (OR 16, 95% CI 3 to 94, p=0.02), immunosuppression (OR 6, 1.3 to 29, p=0.02), HAT (OR 6, 1.6 to 24, p=0.007) and pre-LT colectomy conferred a graft survival benefit (OR 5.6, 1.8 to 17.8, p=0.003). Smoking pre-LT was a predictor of recurrence of IBD post LT (OR 14, 2 to 75, p=0.003). Only 54 patients in the IBD/PSC group (72%) had documented evidence of annual colonoscopy post LT. 36% of patients (8/75) required colectomy in the IBD/PSC group; six for severe disease and two for de-novo neoplasia. A higher rate of neoplasia was seen in the IBD/PSC group (70% vs 30%). Duration of PSC pre-LT was predictive of rPSC (OR 1.03, 1.01 to 1.05, p=0.002). Multivariate analysis: only active colitis was a predictor of graft survival (OR 14, 2 to 100, p=0.01). Conclusion Patient survival post LT for PSC with or without IBD appeared similar. Patients with IBD/PSC are at increased risk of thrombotic events compared to PSC patients post-LT. Optimising management of IBD, including consideration of colectomy, may improve outcomes post LT.