Better transplant-free survival for colectomy with ileostomy in PSC patients

Primary sclerosing cholangitis patients who received colectomy with ileostomy had a higher survival chance without liver transplant than those without surgery.

The microbiome may influence the course of PSC

A retrospective cohort study explored the effect of proctocolectomy with ileostomy on transplant-free survival in patients with PSC1. The study introduced colectomy as a time depended variable and corrected for known risk factors like age, sex, concomitant inflammatory bowel disease (IBD) or autoimmune hepatitis, and enrolment in a tertiary centre of care. 

The trial enrolled 1,341 adult patients from the EpiPSC2 cohort between 2008 and 2021, leading to over 14,000 patient years of follow-up. The mean age at PSC diagnosis was 39 and 64% were men. Most patients had large duct PSC (86%) and 68% had been diagnosed with IBD. Most of the observed colectomies were indicated by dysplasia/neoplasia or active colitis. During follow-up, the median transplant-free survival was about 19 years. 

PSC with Ileostomy: hints at better transplant-free survival rates

“We observed 370 liver transplants and almost 400 deaths, of which PSC-related deaths were most common in this group,” Dr Bregje Mol (Amsterdam UMC, the Netherlands) stated. Comparison between no colectomy, colectomy with remnant colon, or proctocolectomy with ileostomy showed a protective effect of proctocolectomy with ileostomy with regard to liver transplantation and PSC-related death (HR 0.47; 95% CI 0.24–0.93). For other forms of colectomy with residual colon, no benefit was found. Interestingly, IBD status of the patients had no impact. 

“In our data, PSC with Ileostomy seems to be associated with a better transplant-free survival which points towards a role of the colonic microbiota in the disease course of PSC. That is because you only see this effect when you perform a colectomy with ileostomy, so no colonic microbiota can remain and this effect was not seen with any remnant colon function,” Dr Mol concluded.

  1. Mol B, et al. Proctocolectomy with permanent ileostomy is associated with better transplant-free survival in patients with primary sclerosing cholangitis: a retrospective cohort study. LB02, UEG Week 2022, Vienna, Austria, 8–11 October.