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TO THE EDITORS:

We thank Dr. Yarze for his comments on the practice guideline entitled “Long-Term Management of the Successful Adult Liver Transplant”[1] from the American Association for the Study of Liver Diseases. We agree that it would be preferable for all clinical guidelines making reference to inflammatory bowel disease to use a common nomenclature. Furthermore, our intention was to indicate that for liver transplant recipients with primary sclerosing cholangitis (PSC) and colitis-associated dysplasia, colectomy should not be restricted to those with the most severe (ie, high-grade) histopathological features. As such, we will amend the guideline in its online form to read as follows:

42. Patients with PSC and inflammatory bowel disease or other established risk factors for colorectal cancer should undergo an annual screening colonoscopy with biopsies. Colectomy, including continence-preserving pouch operations, should be considered when colonic biopsy reveals dysplasia (grade 1, level B).

  • Michael R. Lucey, M.D.1

  • Norah Terrault, M.D., M.P.H.2

  • 1Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadison, WI

  • 2Gastroenterology DivisionDepartment of MedicineUniversity of California San FranciscoSan Francisco, CA

REFERENCE

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  • 1
    Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E, Teperman LW. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013;19:3-26.