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Dysplasia in ulcerative colitis before and after liver transplantation

The latest issue of the Alimentary Pharmacology & Therapeutics investigates the fate of indefinite and low-grade dysplasia in ulcerative colitis and primary sclerosing cholangitis colitis before and after liver transplantation.

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Patients with primary sclerosing cholangitis and ulcerative colitis (UC) are at an increased risk of colorectal neoplasia, but it is unknown if liver transplantation alters neoplasia progression.

Dr Eaton and colleagues from Minnesota, USA examined the natural history of indefinite dysplasia (IND) and low-grade dysplasia that develop in patients with primary sclerosing cholangitis-UC with and without liver transplantation.

The team performed a retrospective review of patients with primary sclerosing cholangitis and UC between 1993 and 2011 who were diagnosed with IND or low-grade dysplasia before or after liver transplantation for primary sclerosing cholangitis.

The team's primary end point was neoplasia progression or persistent low-grade dysplasia.

5-ASA use was associated with a decreased risk of neoplasia progression
Alimentary Pharmacology & Therapeutics

The research team examined 96 patients.

For the IND group, multifocal lesions were significantly associated with time to neoplasia progression, while 5-aminosalicylate (5-ASA) use was protective.

For patients with low-grade dysplasia, multifocal lesions were significantly associated with the primary end point, while liver transplantation was protective.

Dr Eaton's team concluded, "In primary sclerosing cholangitis-UC patients with IND, 5-ASA use was associated with a decreased risk of neoplasia progression, regardless of transplant status."

"In contrast, multifocal IND and low-grade dysplasia were associated with neoplasia progression or persistent low-grade dysplasia."

"Patients who developed low-grade dysplasia following liver transplantation for primary sclerosing cholangitis were less likely to have progressive neoplasia or persistent low-grade dysplasia, compared with those who had not been transplanted."

Aliment Pharmacol Ther 2013: 38(8): 977–987
08 October 2013

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