Abstract
To assess whether or not liver transplantation and subsequent immunosuppression with cyclosporine and prednisone affect ulcerative colitis symptomatology, we surveyed by questionnaire all 23 surviving patients with pretransplant colonoscopy-documented ulcerative colitis who were transplanted for primary sclerosing cholangitis between June 1982 and September 1985. At follow-up [89.8±7.6 weeks (mean±sem], all six patients who had had asymptomatic colonoscopy-documented ulcerative colitis reported continued ulcerative colitis quiescence. Among the 17 patients who had had symptomatic colonoscopydocumented ulcerative colitis at time of liver transplantation, 88.2% reported improvement in overall ulcerative colitis severity (P<0.001), with significant improvement in the frequency of bowel movements reported by 100%, in crampy abdominal pain by 87.5%, in bowel urgency by 75%, in the occurrence of pus or mucus in stool by 87.5%, in the incidence of ulcerative colitis flares by 81.8%, and in the number of days unable to function normally due to ulcerative colitis symptoms by 78.6% (all at leastP<0.01). These data demonstrate that ulcerative colitis symptom severity significantly improves following liver transplantation with immunosuppression with cyclosporine and prednisone.
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Schrumpf E, Fausa O, Elgjo K, Kolmannskog F: Hepatobiliary complications of inflammatory bowel disease. Semin Liver Dis 8:209–209, 1988
LaRusso NF, Wiesner RH, Ludwig J, MacCarty RL: Primary sclerosing cholangitis. N Engl J Med 310:899–903, 1984
Wiesner RH, LaRusso NF: Clinicopathologic features of the syndrome of primary sclerosing cholangitis. Gastroenterology 79:200–206, 1980
Wiesner RH, LaRusso NF, Ludwig J, Disckson ER: Comparison of the clinicopathologic features of primary sclerosing cholangitis and primary biliary cirrhosis. Gastroenterology 88:108–114, 1985
MacCarty RL, LaRusso NF, Wiesner RH, Ludwig J: Primary sclerosing cholangitis: Findings on cholangiography and pancreatography. Radiology 149:39–44, 1983
Lebovic E, Palmer M, Noo J, Schaffner F: Outcome of primary sclerosing cholangitis: Analysis of long-term observation of 38 patients. Arch Intern Med 147:729–731, 1987
Helzberg JH, Petersen JM, Boyer JL: Improved survival with primary sclerosing cholangitis. A review of clinicopathologic features and comparison of symptomatic and asymptomatic patients. Gastroenterology 82:1869–1875, 1987
Aadland E, Schrumpf E, Fausa O, Elgjo K, Heilo A, Aakhus T, Gjone E: Primary sclerosing cholangitis: A long-term follow-up study. Scand J Gastroenterol 22:655–664, 1987
Marsh JW Jr, Iwatsuki S, Makowka L, Esquivel CO, Gordon RD, Todo S, Tzakis A, Miller C, Van Thiel DH, Starzl TE: Orthotopic liver transplantation for primary sclerosing cholangitis. Ann Surg 207:21–25, 1988
Maddrey WC, Van Thiel DH: Liver transplantation; an overview. Hepatology 8:948–959, 1988
Starzl TE, Iwatsuki S, Van Thiel DH, Gartner JC, Zitelli BJ, Malatack JJ, Schade RR, Shaw BW, Jr, Hakala TR, Rosenthal JT, Porter KA: Evolution of liver transplantation. Hepatology 2:614–636, 1982
Jenkins RL: Liver transplantation in the adult. Transplant Rev 1:1–30, 1987
Esquivel CO, Marsh JW, Van Thiel DH: Liver transplantation for chronic cholestatic liver disease in adults and children. Gastroenterol Clin North Am 17:145–156, 1988
Bodenheimer HC Jr, LaRusso NF, Thayer WR Jr, Charland C, Staples P, Ludwig J: Elevated circulating immune complexes in primary sclerosing cholangitis. Hepatology 3:150–154, 1983
Lindor KD, Wiesner RH, LaRusso NF, Beaver SJ, Kutzmann JA: Lymphocyte subsets in primary sclerosing cholangitis. Dig Dis Sci 32:720–725, 1987
Zacli D, Schrumpf E, Crespic, Cassami F, Fausa O, Aadland E: An autoantibody profile in primary sclerosing cholangitis. J Hepatol 5:14–18, 1987
Lindos KD, Wiesner RH, LaRusso NF, Homburger HA: Enhanced autoreactivity of T-lymphocytes in primary sclerosing cholangitis. Hepatology 7:884–888, 1987
Si L, Whiteside TL, Schade RR, Starzl TE, Van Thiel DH: T-lymphocyte subsets in liver tissues of patients with primary biliary cirrhosis (PBC), patients with primary sclerosing cholangitis, and normal controls. J Clin Immunol 4:262–272, 1984
Josye AD, Esley C, Ahumade J: Family incidence of primary sclerosing cholangitis associated with immunologic disease. Endoscopy 19:114–117, 1987
Peltekian KM, Williams CN, MacDonald AS, Roy P, Czolpinska E: Open study of cyclosporin A (CyA) in Crohn's disease (CD). Gastroenterology 5:1571, 1987
Allison MC, Pounder RE: Ciclosporin for Crohn's disease.In Ciclosporin in Autoimmune Disease. R Schindler (ed). Berlin, Springer-Verlag, 1985, pp 185–187
Gupta S, Keshavarzian A, Hodgson HJF: Cyclosporin in ulcerative colitis. Lancet 2:1277–1278, 1984
Tarter R, Van Thiel D, Hegedus A, Schade R, Gavaler JS, Starzl TE: Neuropsychiatric status after liver transplantation. J Lab Clin Med 103:776–782, 1984
Tarter RE, Erb S, Biller PA, Switala JA, Van Thiel, DH: The quality of life following liver transplantation: A preliminary report. Gastroenterol Clin North Am 17:209–218, 1988
Tarter RE, Switala JA, Carra J, Edwards KL, Van Thiel DH: Inflammatory bowel disease: Psychiatric status before and after disease onset. Int J Psychiatry Med 17:173–181, 1987
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This work was supported in part by NIDDK grant DK 32556 and by NIAAA grant AA06601.
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Gavaler, J.S., Delemos, B., Belle, S.H. et al. Ulcerative colitis disease activity as subjectively assessed by patient-completed questionnaires following orthotopic liver transplantation for sclerosing cholangitis. Digest Dis Sci 36, 321–328 (1991). https://doi.org/10.1007/BF01318204
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DOI: https://doi.org/10.1007/BF01318204