Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2018; 24(28): 3171-3180
Published online Jul 28, 2018. doi: 10.3748/wjg.v24.i28.3171
Role of colectomy in preventing recurrent primary sclerosing cholangitis in liver transplant recipients
Bettina M Buchholz, Panagis M Lykoudis, Reena Ravikumar, Joerg M Pollok, Giuseppe K Fusai
Bettina M Buchholz, Panagis M Lykoudis, Reena Ravikumar, Joerg M Pollok, Giuseppe K Fusai, Department of HPB Surgery and Liver Transplantation, Royal Free Hospital London, London NW32QG, United Kingdom
Author contributions: Buchholz BM, Lykoudis PM, Ravikumar R, Pollok JM and Fusai GK designed the study; Buchholz BM and Lykoudis PM performed the literature review and data analysis; Buchholz BM, Lykoudis PM, Ravikumar R and Fusai GK interpreted the data; Buchholz BM wrote the article; Lykoudis PM, Ravikumar R, Pollok JM and Fusai GK critically revised the manuscript for intellectual content; all authors gave final approval of the final version.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giuseppe Kito Fusai, MSc, FRCS, Surgeon, Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Pond Street, London NW32QG, United Kingdom. g.fusai@ucl.ac.uk
Telephone: +44-20-78302431 Fax: +44-20-78302688
Received: May 15, 2018
Peer-review started: May 16, 2018
First decision: June 6, 2018
Revised: July 8, 2018
Accepted: July 16, 2018
Article in press: July 16, 2018
Published online: July 28, 2018
ARTICLE HIGHLIGHTS
Research background

Recurrence of PSC (rPSC) following liver transplantation occurs in up to a quarter of transplant recipients. Prophylactic colectomy has been proposed as a strategy to reduce the incidence of rPSC.

Research motivation

Current literature on the benefit of prophylactic colectomy for prevention of rPSC post liver transplantation does not include any randomized controlled trials. Findings of reported studies need thus to be examined in a critical way, to assess strength of current evidence and to highlight areas for future improvement.

Research objectives

This study aims to critically review the existing evidence regarding prophylactic colectomy for prevention of post liver transplant rPSC, to evaluate reported studies and to identify shortcomings that should be addressed in future studies.

Research methods

A systematic review was carried out, using structured search terms and a reproducible study selection procedure. Data were extracted and tabulated. The quality of the included studies was evaluated according to modified methodological index for non-randomized studies criteria.

Research results

From a total of 180 publications, 6 were included in the final analysis and all of them were retrospective cohort studies. There was significant heterogeneity in the studied samples, regarding other prognostic factors as well as timing and type of colectomy, but the overall evidence favoured a protective role of pre-/peri- liver transplantation (LT) colectomy in rPSC.

Research conclusions

This study reviews and reports the results of the existing literature in a systematic and objective way. In the absence of randomized prospective studies, such an approach is indicated for drawing conclusions based on findings of retrospective cohort studies. It confirms the overall impression that colectomy might convey protection against rPSC after LT, but the current literature cannot provide definite answers. Finally, our work identifies a lack of comparable groups and failure to report loss to follow-up as the main limitations of reported studies.

Research perspectives

According to the findings of the present study, prophylactic colectomy seems to play a protective role in rPSC post LT, but the existing evidence is not strong. The question would be better answered through prospective randomized trials. It is understood though that such attempt might face several difficulties, particularly in terms of sample size. Alternatively, if retrospective studies were to be carried out, they should include comparison between two groups, those who undergo prophylactic colectomy and those who don’t, and patients’ characteristics, follow-up and outcomes should be reported in a more detailed way.