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Effect of liver transplantation on inflammatory bowel disease in patients with primary sclerosing cholangitis

Wieand, S and Subotin, M and Dvorchik, I and Abu-Elmagd, KM and Starzl, TE and Fung, JJ and Demetris, AJ (2002) Effect of liver transplantation on inflammatory bowel disease in patients with primary sclerosing cholangitis. Hepatology, 35 (2). 380 - 384. ISSN 0270-9139

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Abstract

This report investigates the influence of liver transplantation and concomitant immunosuppression on the course of progression of inflammatory bowel disease (IBD) and discusses statistical methodology appropriate for such settings. The data on 303 patients who underwent liver transplantation for primary sclerosing cholangitis (PSC) were analyzed using person-time analysis and Cox regression, with the duration of IBD as the time variable and transplantation as a segmented time-dependent covariate, to take into account both posttransplant and pretransplant history of IBD. The need for colectomy and appearance of colorectal cancer were taken as outcome measures. The only significant risk factor in the multivariate model for colectomy was transplantation itself, which increased the risk of colectomy due to intractable disease (Wald statistic; P =.001). None of the variables available for analysis were found to influence the risk of colon cancer significantly. Graphs showing the dependence of the instantaneous risk of cancer on the time from onset of IBD and its independence from the latter in the case of colectomy are presented. The use of a unique statistical methodology described for the first time in this setting led us to the somewhat surprising conclusion that transplantation and concomitant use of immunosuppression accelerate the progression of IBD. At the same time, transplantation does not affect the incidence of colorectal cancer. These results confirm the findings of some recent studies and can potentially shed new light on the disease pathogenesis.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Wieand, S
Subotin, M
Dvorchik, I
Abu-Elmagd, KM
Starzl, TEtes11@pitt.eduTES11
Fung, JJ
Demetris, AJ
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 2002
Date Type: Publication
Journal or Publication Title: Hepatology
Volume: 35
Number: 2
Page Range: 380 - 384
DOI or Unique Handle: 10.1053/jhep.2002.30695
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0270-9139
Other ID: uls-drl:31735062120740, Starzl CV No. 2166
Date Deposited: 08 Apr 2010 17:37
Last Modified: 02 Feb 2019 13:57
URI: http://d-scholarship.pitt.edu/id/eprint/5552

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