title: Immunosuppression after liver transplantation for primary sclerosing cholangitis influences activity of inflammatory bowel disease.
abstract: OBJECTIVE
  Previous studies have shown conflicting results regarding the course of inflammatory bowel disease (IBD) after liver transplantation in patients with primary sclerosing cholangitis (PSC). We studied the progression of IBD in patients with PSC who have undergone liver transplantation. We also studied risk factors, including medical therapy, that could influence on IBD disease activity.
  
  
  METHODS
  In a longitudinal multicenter study, we analyzed data from the Nordic Liver Transplant Group on 439 patients with PSC who underwent liver transplantation from November 1984 through December 2006; 353 had IBD at the time of transplantation. We compared IBD activity before and after liver transplantation. Two hundred eighteen patients who had an intact colon and had undergone pretransplant and post-transplant colonoscopies were characterized further.
  
  
  RESULTS
  Macroscopic colonic inflammation was more frequent after liver transplantation than before liver transplantation (153 vs 124 patients; P < .001). The degree of inflammation decreased in 37 patients (17%), was unchanged in 93 patients (43%), and increased in 88 patients (40%) (P < .001). The rate of relapse after transplantation was higher than that before transplantation (P < .001), and overall clinical IBD activity also increased (P < .001). Young age at diagnosis of IBD and dual treatment with tacrolimus and mycophenolate mofetil were significant risk factors for increased IBD activity after transplantation, whereas combination treatment with cyclosporin A and azathioprine had protective effects.
  
  
  CONCLUSIONS
  Immunosuppression affects IBD activity after liver transplantation in patients with PSC; a shift from present standard maintenance treatment of tacrolimus and mycophenolate mofetil to cyclosporin A and azathioprine should be considered for these patients.
authors: Section for Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. krijor@ous-hf.no
authors: Kristin Kaasen
authors: KK
authors: Jørgensen
authors: Lina
authors: L
authors: Lindström
authors: Milada
authors: M
authors: Cvancarova
authors: Tom H
authors: TH
authors: Karlsen
authors: Maria
authors: M
authors: Castedal
authors: Styrbjörn
authors: S
authors: Friman
authors: Erik
authors: E
authors: Schrumpf
authors: Aksel
authors: A
authors: Foss
authors: Helena
authors: H
authors: Isoniemi
authors: Arno
authors: A
authors: Nordin
authors: Kathrine
authors: K
authors: Holte
authors: Allan
authors: A
authors: Rasmussen
authors: Annika
authors: A
authors: Bergquist
authors: Morten H
authors: MH
authors: Vatn
authors: Kirsten Muri
authors: KM
authors: Boberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000276:immunology* / Q000473:pathology*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents