Approximately 80% of patients with primary sclerosing cholangitis (PSC) also have inflammatory bowel disease (IBD). The effect of IBD on the outcomes of liver transplantation (LT) for PSC is unclear. We retrospectively collected data from adults who underwent LT for PSC from 1989 to 2017 in four French LT centers. We compared the rates of patient and graft survivals and of complications after LT. Among 87 patients, 52 (60%) had pre-existing IBD. Excluding those who died within the first 3 months, the 10-year patient survival and graft survival rates were 92.6% (95% confidence interval [CI] 84.3-100) and 77.1% (95% CI 53.8-85.3) in the PSC with IBD (PSC-IBD) group and 97.1% (95% CI 91.4-100) (p = 0.44) and 83.2% (95% CI 69.6-96.9) (p = 0.43) in the isolated PSC group, respectively. Exposure to azathioprine after LT was significantly associated with mortality (odds ratio [OR] 15.55 [95% CI 1.31-184.0], p = 0.03), whereas exposure to mycophenolate mofetil was associated with improved survival (OR 0.17 [95% CI 0.04-0.82], p = 0.03), which may be an era effect. Exposure to cyclosporine was associated with graft loss, albeit at borderline significance: OR 3.60 [95% CI 0.96-13.42] (p = 0.06). The rate of recurrent PSC was 21% in the PSC-IBD group and 11% in the isolated PSC group (p = 0.24). The incidence of severe infection was 125 per 1000 person-years in both groups. Exposure to mycophenolate mofetil was associated with a lower risk of infection (OR 0.26 [95% CI 0.08-0.85] p = 0.03). The presence of IBD was associated with cytomegalovirus infection (OR 3.24 [95% CI 1.05-9.98], p = 0.04). The crude incidence of skin cancer was higher in the PSC-IBD group (p = 0.06). One case of colorectal cancer occurred in a patient with IBD. CONCLUSION: IBD prior to LT for PSC may not affect patient or transplant survival but may increase the risk of cytomegalovirus infection.
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