Role of colectomy in preventing recurrent primary sclerosing cholangitis in liver transplant recipients

Table 1 Methodological index for non-randomized studies criteria for selected studies on recurrent primary sclerosing cholangitis after liver transplantation

		Study design				Data recording and data quality			Study assessment		MINORS score
Ref.	Year	Study aim	Consecutive patients	Data collection	Reported endpoints	Equivalent groups	Follow-up period	Loss tofollow-up	Outcome evaluation bias	Statistical methods
Cholongitas et al[21]	2008	2	2	1	1	0	2	0	1	2	11
Alabraba et al[20]	2009	2	2	1	1	0	2	0	2	2	12
Moncrief et al[24]	2010	1	2	1	1	0	2	0	1	2	10
Gelley et al[22]	2014	1	2	1	1	0	0	0	0	0	5
Ravikumar et al[25]	2015	2	2	1	2	0	2	0	2	2	13
Hildebrand et al[23]	2016	2	2	1	1	0	2	0	1	2	11

MINORS: Methodological index for non-randomized studies.

Table 2 Demographics of study cohorts comparing liver transplantation recipients with and without recurrent primary sclerosing cholangitis in the liver graft

Ref.	Year	Study period	Number n(rPSC vs no rPSC)	Time to diagnosis of rPSC (yr)	Follow-up (yr)	Recipient age at LT (yr)	Recipient gender (male)	MELD at LT	Donor age (yr)	Donor gender (male)	Donor type (DBD)
Cholongitas et al[21]	2008	1989-2004	7 (13) vs 46 (87)	5 (0.3-10)1	9.1 (1-15.4)1	35 ± 15 vs 42 ± 132	5 (71) vs 25 (54)	NR	33 ± 18 vs 44 ± 142	6 (86) vs 27 (59)	NR
Alabraba et al[20]	2009	1986-2006	61 (23) vs 202 (77)	4.6 (0.5-12.9)1	6.9 (0-19.9)1	48 (16-72)1	50 (82) vs 149 (74)	NR	NR	NR	61 (100) vs 202 (100)
Moncrief et al[24]	2010	1989-2006	15 (25) vs 44 (75)	3.4 (1.5-5.5)	5.7 (2.8-8.8)	45 (36-53) vs 47 (37-52)	13 (87) vs 33 (75)	18 (13-21) vs 14 (10-21)	NR	NR	NR
Gelley et al[22]	2014	1995-2011	6 (24) vs 19 (76)	NR	NR	27 ± 7 vs 37 ± 122	3 (50) vs 13 (68)	16 ± 5 vs 11 ± 42	39 ± 14 vs 35 ± 112	NR	NR
Ravikumar et al[25]	2015	1990-2010	81 (14) vs 484 (86)	NR	9 (5-14)	43 (34-55) vs 49 (41-57)	61 (75) vs 344 (71)	NR	39 (28-53) vs 43 (32-54)	46 (57) vs 268 (55)	80 (99) vs 467 (96)
Hildebrand et al[23]	2016	1990-2006	62 (20) vs 243 (80)	4.6 (0.5-14.3)3	8.2 (0-22)3	39 ± 11.5 vs 39 ± 10.82	48 (77) vs 160 (66)	16 ± 6 vs 14 ± 72	43.6 ± 16 vs 40.1 ± 16.92	NR	NR

Data are reported as n (%) and median (interquartile range) unless indicated as

¹median (range),

²mean ± SD and

³mean (range). DBD: Donation after brain death; LT: Liver transplantation; MELD: Model of end-stage liver disease; NR: Not reported; rPSC: Recurrent primary sclerosing cholangitis.

Table 3 Summary of study outcomes on impact of colectomy on recurrent primary sclerosing cholangitis, inflammatory bowel disease-specific risk factors and non-inflammatory bowel disease-specific risk factors for recurrent primary sclerosing cholangitis

Ref.	Year	Colectomy	IBD-specific risk factor for rPSC	non-IBD risk factor for rPSC
1Cholongitas et al[21]	2008	No effect	Presence of UC post-LT	Need for maintenance steroids post-LT
Alabraba et al[20]	2009	Protective (pre- and peri-LT)	Presence of intact (i.e., retained) colon (independent of IBD or UC)	EDC grafts
Moncrief et al[24]	2010	No effect	None	At least one episode of ACR; CMV mismatch
Gelley et al[22]	2014	No effect	Severe active IBD	Higher donor BMI Younger recipient age
1Ravikumar et al[25]	2015	Protective (univariate analysis)	Presence of UC post-LT	Younger recipient age
Hildebrand et al[23]	2016	No effect	IBD, UC, and in particular active colitis post-LT	Higher donor age; Higher INR at LT

¹Studies reporting exclusively on ulcerative colitis. ACR: Acute cellular rejection; BMI: Body mass index; CMV: Cytomegalovirus; EDC: Extended donor criteria; IBD: Inflammatory bowel disease; INR: International normalized ratio; LT: Liver transplantation; rPSC: Recurrent primary sclerosing cholangitis; UC: Ulcerative colitis.

Table 4 Primary outcomes of study cohorts comparing liver transplantation recipients with and without recurrent primary sclerosing cholangitis in the liver graft

Ref.	Year	Presence of IBD(ever)	Time of IBD diagnosis (pre-LT/de novo)	Presence of IBD (post-LT)	Time of colectomypre- and peri-LT/post-LT	Type of colectomy	Primary immunosuppression	Secondary immunosuppression
1Cholongitas et al[21]	2008	7 (100) vs 26 (56)	5 (71)/2 (29) vs 25 (54)/1 (2)	7 (100) vs 26 (56)	0 (0)/1 (14) vs 6 (13)/6 (13)	NR	TAC 2 (29) vs 25 (54) CyA 5 (71) vs 21 (46)	AZA 3 (43) vs 22 (48) OKT3 or ATG 2 (29) vs 11 (24)
Alabraba et al[20]	2009	39 (72) vs 123 (70)	NR	NR	1 (2)/14 (23) vs 28 (16)/18 (10)	Panproctocolectomy 7 (13) vs 15 (8) Segmental + subtotal 5 (9) vs 21 (12) Ileoanal pouch 3 (6) vs 10 (6)	TAC 16 (26) vs 104 (51) CyA 44 (72) vs 95 (47)	None 1 (2) vs 3 (2) OKT3 0 (0) vs 2 (2)
Moncrief et al[24]	2010	15 (100) vs 33 (75)	11 (73)/4 (27) vs 31 (70)/2 (5)	13 (87) vs 24 (55)	1 (7)/NR vs 9 (20)/NR	NR	TAC 7 (47) vs 28 (64) CyA 8 (53) vs 14 (32)	NR
Gelley et al[22]	2014	6 (100) vs 15 (79)	5 (83)/1 (17) vs 14 (74)/1 (5)	6 (100) vs 15 (79)	0 (0)/2 (34) vs 4 (21)/2 (11)	NR	TAC 4 (67) vs 14 (74) CyA 2 (33) vs 5 (26)	NR
1Ravikumar et al[25]	2015	51 (78) vs 220 (52)	42 (65)/9 (13) vs 193 (46)/27 (6)	43 (66) vs 181 (42)	5 (6)/14 (17) vs 40 (8)/46 (10)	Panproctocolectomy: 2 (2) vs 22 (5) Segmental + subtotal: 16 (20) vs 41 (8) Other: 1 (1) vs 17 (4)	TAC 36 (44) vs 330 (68) CyA 20 (25) vs 55 (11)	AZA 26 (32) vs 212 (44) MMF 10 (12) vs 67 (14) Steroids 38 (47) vs 285 (59)
Hildebrand et al[23]	2016	53 (86) vs 167 (71)	NR	48 (77) vs 138 (59)	NR	NR	TAC 41 (67) vs 150 (66) CyA 32 (53) vs 124 (55)	Steroids 41 (70) vs 133 (60)

Data are expressed as n (%).

¹Studies reporting exclusively on ulcerative colitis. ATG: Anti-thymocyte globulin; AZA: Azathioprine; CyA: Cyclosporine A; IBD: Inflammatory bowel disease; LT: Liver transplantation; MMF: Mycophenolate mofetil; NR: Not reported; OKT3: Muromonab-CD3; TAC: Tacrolimus.