Ileal pouch-anal anastomosis and end ileostomy result in equivalent graft survival following liver transplantation for inflammatory bowel disease-primary sclerosing cholangitis.
L Schabl, S D Holubar, M Maspero, S R Steele, T Hull
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引用次数: 0
Abstract
Introduction: Patients with inflammatory bowel disease and primary sclerosing cholangitis may require both liver transplantation and colectomy. There are concerns about increased rates of hepatic artery thrombosis, biliary strictures, and hepatic graft loss in patients with ileal pouch-anal anastomosis compared to those with end ileostomy. We hypothesized that graft survival was not negatively affected by ileal pouch-anal anastomosis compared to end ileostomy.
Materials and methods: A tertiary center's database was searched for patients meeting the criteria of liver transplantation because of primary sclerosing cholangitis and total proctocolectomy with ileal pouch-anal anastomosis or end ileostomy because of ulcerative colitis. Primary endpoints were hepatic graft survival and post-transplant complications.
Results: Fifty-five patients met the inclusion criteria between January 1990 and December 2022. Of these, 46 (84%) underwent ileal pouch-anal anastomosis, and 9 (16%) underwent end ileostomy. The average age at total proctocolectomy (41.5 vs. 49.1 years; p = 0.12) and sex distribution (female: 26.1% vs. 22.2%; p = 0.99) were comparable. The rates of re-transplantation (21.7% vs. 22.2%; p = 0.99), hepatic artery thrombosis (10.8% vs. 0; p = 0.58), acute rejection (32.6% vs. 44.4%; p = 0.7), chronic rejection (4.3% vs. 11.1%; p = 0.42), recurrence of primary sclerosing cholangitis (23.9% vs. 22.2%; p = 0.99), and biliary strictures (19.6% vs. 33.3%; p = 0.36) were similar between the ileal pouch-anal anastomosis and end ileostomy groups, respectively. None of the end ileostomy patients developed parastomal varices. The log-rank tests for graft (p = 0.97), recipient (p = 0.3), and combined graft/recipient survival (p = 0.73) were similar.
Conclusion: Ileal pouch-anal anastomosis did not negatively affect graft, recipient, and combined graft/recipient survival, or the long-term complications, compared to end ileostomy.
简介炎症性肠病和原发性硬化性胆管炎患者可能需要进行肝移植和结肠切除术。与回肠末端造口术相比，回肠袋-肛门吻合术患者的肝动脉血栓形成率、胆道狭窄率和肝移植物丢失率都会增加，这一点令人担忧。我们假设，与回肠造口术相比，回肠袋-肛门吻合术不会对移植物存活率产生负面影响：我们在一家三级中心的数据库中搜索了符合因原发性硬化性胆管炎进行肝移植和因溃疡性结肠炎进行回肠袋-肛门吻合术或回肠末端造口术的标准的患者。主要终点是肝移植存活率和移植后并发症：1990年1月至2022年12月期间，55名患者符合纳入标准。其中46人（84%）接受了回肠袋-肛门吻合术，9人（16%）接受了回肠末端造口术。全直肠切除术的平均年龄（41.5 岁 vs. 49.1 岁；p = 0.12）和性别分布（女性：26.1% vs. 22.2%；p = 0.99）相当。再次移植率（21.7% vs. 22.2%；p = 0.99）、肝动脉血栓形成率（10.8% vs. 0；p = 0.58）、急性排斥反应率（32.6% vs. 44.4%；p = 0.7）、慢性排斥反应率（4.3% vs. 11.1%；p = 0.42）、原发性浆膜炎复发率（26.1% vs. 22.2%；p = 0.99）、肝动脉血栓形成率（10.8% vs. 0；p = 0.58）、急性排斥反应率（32.6% vs. 44.4%；p = 0.7）、慢性排斥反应率（4.3% vs. 11.1%；p = 0.42）、原发性硬化性胆管炎复发（23.9% vs. 22.2%; p = 0.99）和胆道狭窄（19.6% vs. 33.3%; p = 0.36）在回肠袋-肛门吻合组和回肠末端造口组中分别相似。回肠末端造口术患者均未出现吻合口旁静脉曲张。移植物存活率（p = 0.97）、受体存活率（p = 0.3）和移植物/受体联合存活率（p = 0.73）的对数秩检验结果相似：结论：与回肠末端造口术相比，回肠袋-肛门吻合术不会对移植物、受体和移植物/受体合并存活率或长期并发症产生负面影响。
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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