P216 Does mucosal inflammation drive recurrence of PSC in liver transplant recipients with ulcerative colitis?

Abstract

Background: primary sclerosing cholangitis (PSC) associated to inflammatory bowel disease (IBD) drastically increases the risk of liver and colonic complications. However, no specific screening is recommended. The local IBD unit proposed to perform systematic screening by liver biopsy during a surgery for IBD. The aims of the study were to assess the frequency, characteristics and outcomes of patients with inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC) on systematic liver biopsy during a surgery for IBD. Method(s): All chart of patients who underwent a major abdominal surgery related to IBD in a single centre were reviewed. IBD phenotype and outcomes were assessed according to the presence of PSC. Colorectal neoplasia was defined by the onset of dysplasia or adenocarcinoma during the follow-up. Result(s): Between 1998 and 2011, 390 IBD patients were operated and followed-up for 68 months [14; 118], 255 systematic peroperative liver biopsies were performed. The incidence of PSC was 12.8%. Twenty-two patients with PSC on 29 (75.9%) had normal liver biochemistry at the time of surgery, and 18 PSC patients on 41 (43.9%) presented no abnormality during the follow-up. No patient underwent liver transplantation. Demographic, IBD phenotype and IBD outcomes were broadly comparable according to PSC status except for disease location: while colitis was more frequent in PSC group, the rate of extensive colitis was similar across groups. Among the IBD population, 27 (6.9%) colorectal neoplasia occurred, including 8 (29.6%) in patients with PSC. The cumulative risk of developing colorectal neoplasia from IBD diagnosis was 1.1%, 3.5%, 10.6%, 19.6 % at 5, 10, 20, 30 years, respectively (Figure). Neoplasia was mostly multifocal (40.7%). By multivariate analysis, PSC strongly increased the risk of developing neoplasia, with an HR = 2.51 [1.01; 5.8] . Extensive colitis also increased the risk of neoplasia (HR = 2.71 [1.004; 9.49]). The use of immunosuppressant drugs and/or biotherapy trended to be independently associated with a decrease risk of colorectal neoplasia (HR = 0.46 [0.21; 1.02], p = 0.05). (Figure presented) Conclusion(s): Asymptomatic forms of PSC are frequently associated to IBD and alter the prognosis of patients with colitis through colorectal neoplastic complications, favouring a systematic screening of PSC in these patients, including peroperative liver biopsy.