title: Oral budesonide for the therapy of post-liver transplant de novo inflammatory bowel disease: a case series and systematic review of the literature.
abstract: BACKGROUND
  The therapy for posttransplant IBD is clinically challenging. Patients receiving liver transplants are immunosuppressed to prevent rejection, but via an unknown mechanism develop de novo IBD in spite of receiving some of the same medications used for therapy in traditional IBD. In the published literature most of the patients who developed de novo IBD were treated with traditional corticosteroids. Exposure to systemic corticosteroids increases risks of infection, diabetes mellitus, and osteoporosis among other complications. Budesonide, a luminally active steroid with low systemic absorption, is an established therapeutic agent for IBD that should receive special considerations as first-line therapy in this patient population.
  
  
  METHODS
  We describe 3 cases of de novo IBD after liver transplantation. None of these patients had a history of IBD prior to their transplant. All 3 were treated with oral budesonide in lieu of systemic corticosteroids. Additionally, a Medline MeSH search was performed using the terms "inflammatory bowel disease" and "liver transplant" as part of a systematic review of the literature.
  
  
  RESULTS
  All 3 cases of de novo post transplant IBD went into clinical remission with oral budesonide. The Medline search ultimately revealed 19 case reports, case series or retrospective reviews on de novo post liver transplant IBD. Most reports focused on the diagnosis and risk factors and did not have an emphasis on therapy.
  
  
  CONCLUSIONS
  Given the track record for budesonide in traditional IBD, and its documented efficacy and systemic steroid-sparing benefit, in our opinion this drug should be considered first-line therapy for de novo posttransplant IBD.
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina 27599-7080, USA. abarritt@unch.unc.edu
authors.forename: A Sidney
authors.initials: AS
authors.lastname: Barritt
authors.forename: Steven L
authors.initials: SL
authors.lastname: Zacks
authors.forename: Tara C
authors.initials: TC
authors.lastname: Rubinas
authors.forename: Hans H
authors.initials: HH
authors.lastname: Herfarth
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000284:Administration, Oral; D019819:Budesonide / Q000008:administration & dosage; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D011183:Postoperative Complications / Q000188:drug therapy / Q000821:virology
chemical_list: D019819:Budesonide; D007166:Immunosuppressive Agents