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Given the co\u2010existence with colitis, patients may also require colectomy; a factor potentially conferring improved post\u2010transplant outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the impact of restorative surgery via ileal pouch\u2010anal anastomosis (<jats:styled-content style=\"fixed-case\">IPAA<\/jats:styled-content>) vs retaining an end ileostomy on liver\u2010related outcomes post\u2010transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Graft survival was evaluated across a prospectively accrued transplant database, stratified according to colectomy status and type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 1990 and 2016, 240 individuals with <jats:styled-content style=\"fixed-case\">PSC<\/jats:styled-content>\/colitis underwent transplantation (cumulative 1870 patient\u2010years until first graft loss or last follow\u2010up date), of whom 75 also required colectomy. A heightened incidence of graft loss was observed for the <jats:styled-content style=\"fixed-case\">IPAA<\/jats:styled-content> group vs those retaining an end ileostomy (2.8 vs 0.4 per 100 patient\u2010years, log\u2010rank <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005), whereas rates between <jats:styled-content style=\"fixed-case\">IPAA<\/jats:styled-content> vs no colectomy groups were not significantly different (2.8 vs 1.7, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.1). In addition, the ileostomy group experienced significantly lower graft loss rates vs. patients retaining an intact colon (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.044). The risks conferred by <jats:styled-content style=\"fixed-case\">IPAA<\/jats:styled-content> persisted when taking into account timing of colectomy as related to liver transplantation via time\u2010dependent Cox regression analysis. Hepatic artery thrombosis and biliary strictures were the principal aetiologies of graft loss overall. Incidence rates for both were not significantly different between <jats:styled-content style=\"fixed-case\">IPAA<\/jats:styled-content> and no colectomy groups (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.092 and <jats:italic>P<\/jats:italic>\u00a0=\u00a00.358); however, end ileostomy appeared protective (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.007 and 0.031, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In <jats:styled-content style=\"fixed-case\">PSC<\/jats:styled-content>, liver transplantation, colectomy\u00a0+\u00a0<jats:styled-content style=\"fixed-case\">IPAA<\/jats:styled-content> is associated with similar incidence rates of hepatic artery thrombosis, recurrent biliary strictures and re\u2010transplantation compared with no colectomy. Colectomy\u00a0+\u00a0end ileostomy confers more favourable graft outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14828","type":"journal-article","created":{"date-parts":[[2018,6,8]],"date-time":"2018-06-08T08:44:35Z","timestamp":1528447475000},"page":"322-332","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["The impact of ileal pouch\u2010anal anastomosis on graft survival following liver transplantation for primary sclerosing cholangitis"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4009-8087","authenticated-orcid":false,"given":"P. 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