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- W2044988894 abstract "We appreciate the comments from Drs Cholangitas and Burroughs on our recent study.1 We reported that colitis remained quiescent or improved after orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) in patients with a co-existent diagnosis of ulcerative colitis (UC).2 Patients without UC before OLT were excluded in our study.2 In particular, the two patients who developed UC after OLT had biopsies of their colon before OLT. Thus, development of UC after OLT would not be classified as worsening of underlying UC after OLT in these patients. The pathogenesis of de novo UC after OLT remains unclear with damage associated molecular patterns and pathogen associated molecular patterns playing a predominant role.3 We agree that different definitions were used in both studies for quiescent and active UC, which may have altered the results.2, 4 Although we did not use the Truelove and Witt's criteria for defining UC exacerbation, we evaluated the activity of UC endoscopically and histologically before and after OLT.2 We excluded patients with steroid use for acute rejection so that we could define the number of actual flares of UC requiring steroids that occurred following OLT. However, we do agree that use of steroids for acute rejection might have affected our results in terms of UC flare following OLT. With regard to the use of steroids and the risk of recurrence of PSC, there was no direct relationship between the activity of UC and the risk of PSC recurrence in the study.5 As there were only 7 patients with PSC recurrence, the sample size was too small to make any conclusive recommendations.5 Furthermore, the risk of PSC recurrence with UC activity has not been reported in studies from other centres.6 We do agree that prior to OLT, an inverse correlation between PSC and UC activity exists.7 However, in the post-OLT setting, once the diseased liver has been removed; lymphocyte-trafficking back to the colon may be affected by a number of confounding factors such as the use of immunosuppression. Future research that evaluates the relationship between colon inflammation and PSC may clarify this question. Declaration of personal and funding interests: None." @default.
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- W2044988894 date "2012-07-01" @default.
- W2044988894 modified "2023-09-23" @default.
- W2044988894 title "Letter: ulcerative colitis in patients transplanted for primary sclerosing cholangitis - authors’ reply" @default.
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- W2044988894 doi "https://doi.org/10.1111/j.1365-2036.2012.05178.x" @default.
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