We thank Dr. Yarze for his comments on the practice guideline entitled “Long-Term Management of the Successful Adult Liver Transplant” 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