Inflammatory Bowel Disease Outcomes and Management Following Liver Transplantation for Primary Sclerosing Cholangitis: A Single Center Study
Bibliographic record
Abstract
Introduction: The aim of this study is to help better define the outcomes and management of patients with inflammatory bowel disease (IBD) after liver transplantation for primary sclerosing cholangitis (PSC). Methods: This is a retrospective study examining the IBD outcomes and management following liver transplant for PSC at a single liver transplant center from the years 2007-2015. Results:Baseline Characteristics: Of the 30 patients that received a liver transplant for PSC, 19 had inflammatory bowel disease prior to transplant--15 with ulcerative colitis (UC) and 4 with Crohn's disease (CD). Baseline disease and endoscopic activity before transplant: Of the UC patients, 85% had minimal to mild clinical disease activity based on Montreal classification, and 69% had minimal to mild endoscopic findings based on Mayo Clinic endoscopic scoring. All CD patients were in remission based on clinical disease activity index scores and none had stricturing or fistualizing disease. Most patients were on minimal IBD drug therapy prior to transplant: 76% were on 5-ASA compounds alone; only 12% immunomodulatory therapy, and only one patient was on anti-TNF therapy. Disease and endoscopic activity after transplant: Of the UC patients, clinical disease activity remained the same in 70%, improved in 15%, and worsened in 15%; of the UC patients that had comparative colonoscopies available after transplantation for review, 22% had improved endoscopic scores, 44% had the same scores and 33% had worse scores. Of the CD patients, all but 1 remained in remission. Only 3 IBD patients experienced significant flares after transplant; all were successfully managed, including one patient with the addition of Imuran and another patient with the addition of an anti-TNF drug to baseline 5-ASA drug therapy. No patient required colectomy. Major IBD related complications after transplantation: One patient developed de novo Crohn's disease; 2 UC patients developed CMV colitis successfully managed with anti-viral therapy; 1 UC patient developed post-transplant lymphoproliferative disorder of the colon; two UC patients developed Clostridium difficile—one of whom required fecal transplant for recurrent disease. Conclusion: The inflammatory bowel disease clinical activity remained the same or improved after liver transplantation in most patients and only worsened in 15% of patients. Significant post-transplant IBD flares were also successfully managed medically and without the need for surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".