Liver Transplantation Is Associated With a Reduced Risk of Colorectal Dysplasia in Patients With IBD and Concomitant PSC

Nayantara Coelho-Prabhu; Ashwariya Ohri; Clara Benatzky; Nikitha Uma Baskaran; John E Eaton; Konstantinos N Lazaridis; Daniel Pratt; Ashwin N Ananthakrishnan

doi:10.1016/j.cgh.2025.02.024

Liver Transplantation Is Associated With a Reduced Risk of Colorectal Dysplasia in Patients With IBD and Concomitant PSC

Clin Gastroenterol Hepatol. 2025 May 9:S1542-3565(25)00348-9. doi: 10.1016/j.cgh.2025.02.024. Online ahead of print.

Authors

Nayantara Coelho-Prabhu¹, Ashwariya Ohri¹, Clara Benatzky², Nikitha Uma Baskaran³, John E Eaton¹, Konstantinos N Lazaridis¹, Daniel Pratt³, Ashwin N Ananthakrishnan⁴

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Rochester, Minnesota.
² Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine, University Hospital of Würzburg, Würzburg, Germany.
³ Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: aananthakrishnan@mgh.harard.edu.

PMID: 40349894
DOI: 10.1016/j.cgh.2025.02.024

Abstract

Background: Primary sclerosing cholangitis (PSC) affects up to 8% of patients with inflammatory bowel diseases (IBD) (Crohn's disease and ulcerative colitis) and is associated with an increased risk of colorectal neoplasia (CRN), which may be in part due to altered bile acid composition. About 40% of patients with PSC undergo liver transplantation.

Objective: The study sought to examine whether liver transplantation modifies risk of colorectal cancer in patients with PSC and IBD.

Methods: This was a multi-institution retrospective cohort study comparing colon dysplasia/cancer in patients with PSC-IBD who underwent a liver transplantation with those with PSC-IBD without a liver transplant. Our primary outcome was the development of flat or visible colon cancer, low-grade dysplasia, or high-grade dysplasia. Multivariable regression models adjusting for relevant confounders examined effect of liver transplantation on cancer/dysplasia occurrence.

Results: Our study cohort consisted of 320 patients with PSC-IBD with a liver transplant compared with 659 PSC-IBD control subjects without a liver transplant. Most (80%) had ulcerative colitis. During follow-up, 239 (24%) patients developed CRN. On multivariable analysis, adjusting for age, sex, study site, duration of disease, and type of IBD, liver transplantation was associated with a lower risk of colon dysplasia or cancer (odds ratio, 0.66; 95% confidence interval, 0.47-0.93). The findings were unchanged on adjusting for number of surveillance exams, chromoendoscopy, or presence of endoscopically active disease. Dysplasia was more common in patients who developed recurrent PSC after transplantation.

Conclusions: Liver transplantation was associated with a reduced risk of colon cancer/dysplasia in patients with PSC-IBD in our cohort.

Keywords: Cholangitis; Colitis; Colon Cancer; Dysplasia; PSC.