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The management of inflammatory bowel disease (IBD) before and after liver transplantation is complex in patients with primary sclerosing cholangitis–related cirrhosis. A recent study observed that patients with IBD had better control of their colitis posttransplantation if they were on cyclosporine and azathioprine versus tacrolimus and mycophenolate mofetil (NEJM JW Gastroenterol Jun 26 2013). Now, based on a review of state-of-the-science data, researchers suggest approaches for optimal patient management in this complex setting, as follows:
Pretransplantation:
Optimize treatment of IBD.
Refer patients with refractory IBD to surgery in a timely manner prior to the development of cirrhosis.
Conduct annual colonoscopy for surveillance of neopla…