Colectomy type and PSC transplant
Impact of colectomy type following liver transplant for PSC
A research paper was published in June 2018 by a team led by Dr Palak Trivedi (University of Birmingham), looking at the impact of colectomy type following liver transplant for PSC. When colitis does not respond to medical treatment, you may be offered surgery to remove the large intestine (an operation called ‘subtotal colectomy’).
Following the first stage of a colectomy, individuals are left with an ileostomy (stoma), whereby stool from the small intestine left behind empty into a bag attached to the abdomen/outside of the body. However some patients chose to have their stoma joined back to a small remaining part of large intestine at the very tail end / near their bottom (anus). This additional step, wherein the bowel is joined back to continuity, creates what is called an ileal-pouch anal anastomosis (IPAA).
Dr Trivedi found that people with PSC who needed colectomy and retained an end ileostomy experienced fewer complications related to, and after, liver transplantation compared to those who underwent formation of an IPAA.
In addition, patients choosing to keep their ileostomy intact had the lowest risk of needing another transplant, developing PSC recurrence or problems related to liver transplant blood supply compared to the IPAA patient group or those who did not undergo colectomy.
These new findings suggest that keeping an end ileostomy may be protective to the liver following transplantation for PSC. This protective effect was not found for patients needing colectomy who then go onto have their bowel ‘re-connected’ with an IPAA.
The authors speculate that one of the reasons these differences may arise is because there are more episodes of gut inflammation in people with PSC and IPAA (who often develop pouchitis) than in those with an end ileostomy.
While further research is needed, these research findings are important as they allow patients and their healthcare professionals to take more informed decisions if colectomy is needed, particularly when PSC liver disease can progress to the point of needing a liver transplant down the line.
Reviewed by Dr Palak Trivedi, University of Birmingham,12/06/18
Trivedi PJ, Reece J, Laing RW, et al. The impact of ileal pouch-anal anastomosis on graft survival following liver transplantation for primary sclerosing cholangitis. Aliment Pharmacol Ther. 2018;00:1–11. https://doi.org/10.1111/apt.14828