Activity of ulcerative colitis before and after liver transplantation in primary sclerosing cholangitis: the Hungarian experience

Primary sclerosing cholangitis (PSC) is a common cause for liver transplantation (OLT) in Europe. It is frequently associated with inflammatory bowel disease (IBD). PSC associated IBD often runs a quiescent course but becomes more aggressive after OLT in some patients. Our aim was to evaluate the activity of IBD in PSC patients before and after OLT in Hungary. We retrospectively analyzed data from 411 whole-liver transplantations from 1995 to 2010 that included 41 patients transplanted due to PSC (10%). Thirty-one PSC patients had IBD pre-OLT. We used the Mayo score (Disease Activity Index) to assess the severity of ulcerative colitis (UC) before and after OLT. Among 55% of patients who had pancolits, the majority (95%) were inactive or showed only mild activity before transplantation. After transplantation, disease activity was inactive in 10%; mild to moderate in 25% to 25%; and severe in 40% of cases. The Mayo score was higher after transplantation compared with the pretransplant level (2.91 ± 0.9 versus 6.64 ± 3.7, P = .009). Retransplantations (n = 5) were performed only among PSC patients with colonic involvement. In conclusion, the activity of IBD worsens in the majority of patients after OLT. Early colectomy should be considered to prevent severe complications and liver graft impairment.