AIM: To study the published evidence on the impact of colectomy in preventing recurrent primary sclerosing cholangitis (rPSC). METHODS: An unrestricted systematic literature search in PubMed, EMBASE, Medline OvidSP, ISI Web of Science, Lista (EBSCO) and the Cochrane library was performed on clinical studies investigating colectomy in liver transplantation (LT) recipients with and without rPSC in the liver allograft. Study quality was evaluated according to a modification of the methodological index for non-randomized studies (MINORS) criteria. Primary endpoints were the impact of presence, timing and type of colectomy on rPSC. Overall presence of inflammatory bowel disease (IBD), time of IBD diagnosis, posttransplant IBD and immunosuppressive regimen were investigated as secondary outcome. RESULTS: The literature search yielded a total of 180 publications. No randomized controlled trial was identified. Six retrospective studies met the inclusion criteria of which 5 studies were graded as high quality articles. Reporting of IBD was heterogenous but in four publications, either inflammatory bowel disease, ulcerative colitis or in particular active colitis post-LT significantly increased the risk of rPSC. The presence of an intact (i.e., retained) colon at LT was identified as risk factor for rPSC in two of the high quality studies while four studies found no effect. Type of colectomy was not associated with rPSC but this endpoint was underreported (only in 33% of included studies). Neither tacrolimus nor cyclosporine A yielded a significant benefit in disease recurrence of primary sclerosing cholangitis (PSC). CONCLUSION: The data favours a protective role of pre-/peri-LT colectomy in rPSC but the current evidence is not strong enough to recommend routine colectomy for rPSC prevention.
AIM: To study the published evidence on the impact of colectomy in preventing recurrent primary sclerosing cholangitis (rPSC). METHODS: An unrestricted systematic literature search in PubMed, EMBASE, Medline OvidSP, ISI Web of Science, Lista (EBSCO) and the Cochrane library was performed on clinical studies investigating colectomy in liver transplantation (LT) recipients with and without rPSC in the liver allograft. Study quality was evaluated according to a modification of the methodological index for non-randomized studies (MINORS) criteria. Primary endpoints were the impact of presence, timing and type of colectomy on rPSC. Overall presence of inflammatory bowel disease (IBD), time of IBD diagnosis, posttransplant IBD and immunosuppressive regimen were investigated as secondary outcome. RESULTS: The literature search yielded a total of 180 publications. No randomized controlled trial was identified. Six retrospective studies met the inclusion criteria of which 5 studies were graded as high quality articles. Reporting of IBD was heterogenous but in four publications, either inflammatory bowel disease, ulcerative colitis or in particular active colitis post-LT significantly increased the risk of rPSC. The presence of an intact (i.e., retained) colon at LT was identified as risk factor for rPSC in two of the high quality studies while four studies found no effect. Type of colectomy was not associated with rPSC but this endpoint was underreported (only in 33% of included studies). Neither tacrolimus nor cyclosporine A yielded a significant benefit in disease recurrence of primary sclerosing cholangitis (PSC). CONCLUSION: The data favours a protective role of pre-/peri-LT colectomy in rPSC but the current evidence is not strong enough to recommend routine colectomy for rPSC prevention.
Authors: Ulrika Broomé; Hans Glaumann; Eva Lindstöm; Lars Lööf; Sven Almer; Hanne Prytz; Hanna Sandberg-Gertzén; Stefan Lindgren; Frans-Thomas Fork; Gunnar Järnerot; Rolf Olsson Journal: J Hepatol Date: 2002-05 Impact factor: 25.083
Authors: J R Cangemi; R H Wiesner; S J Beaver; J Ludwig; R L MacCarty; R R Dozois; A R Zinsmeister; N F LaRusso Journal: Gastroenterology Date: 1989-03 Impact factor: 22.682
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Authors: Palak J Trivedi; Irene Scalera; Emma Slaney; Richard W Laing; Bridget Gunson; Gideon M Hirschfield; Andrea Schlegel; James Ferguson; Paolo Muiesan Journal: J Hepatol Date: 2017-07-08 Impact factor: 25.083
Authors: Edward Alabraba; Peter Nightingale; Bridget Gunson; Stefan Hubscher; Simon Olliff; Darius Mirza; James Neuberger Journal: Liver Transpl Date: 2009-03 Impact factor: 5.799
Authors: Bertus Eksteen; Allister J Grant; Alice Miles; Stuart M Curbishley; Patricia F Lalor; Stefan G Hübscher; Michael Briskin; Mike Salmon; David H Adams Journal: J Exp Med Date: 2004-11-22 Impact factor: 14.307
Authors: Fotios S Fousekis; Vasileios I Theopistos; Ioannis V Mitselos; Alexandros Skamnelos; Athanasios Kavvadias; Konstantinos H Katsanos; Dimitrios K Christodoulou Journal: J Clin Med Res Date: 2019-01-05