The effect of liver transplantation for primary sclerosing cholangitis on disease activity in patients with inflammatory bowel disease.
Immunosuppressive therapies are indicated following liver transplantation (LT) to prevent graft loss through rejection, and these same agents also may have a role in the management of inflammatory bowel disease (IBD). The aims of this study were to examine the effects of immunosuppression following LT on IBD activity and to identify markers of IBD control post-LT in patients with IBD who underwent LT for primary sclerosing cholangitis (PSC). A retrospective analysis of all adult patients with a pre-LT diagnosis of IBD who underwent LT for PSC over a 15-year period was performed. The primary outcome was IBD activity based on symptomatology and endoscopic assessment. Secondary outcomes included recipient mortality and post-LT development of colorectal cancer or small bowel lymphoma. A total of 105 patients underwent LT for PSC, and IBD was diagnosed in 27 (26%) pre-LT. Patients were followed for a mean of 88.5 months. Fourteen (52%) patients had stable IBD, 6 (22%) had worsening disease, and 7 (26%) had clinical improvement after LT. Colorectal cancer developed in 2 (7%) patients, and small bowel lymphoma developed in 1 (4%) patient. The absence of additional maintenance therapy for IBD was found to be associated with good outcome for IBD control. The use of either infliximab (Remicade, Janssen Biotech) or corticosteroids to control IBD post-LT was associated with poor outcome. Most patients with PSC and IBD had a stable course of IBD post-LT. The need for infliximab or additional or prolonged corticosteroids after LT appears to be a surrogate marker of aggressive disease.
Dr. Mosli, Dr. Qumosani, and Dr. Al-judaibi are affiliated with the Department of Medicine of the Multi-Organ Transplant Unit of the London Health Sciences Centre of the University of Western Ontario in London, Ontario, Canada, where Dr. Beaton and Dr. Chandok are Assistant Professors of Medicine and Dr. Marotta is an Associate Professor of Medicine. Dr. Croome is a Transplant Hepatology Fellow in the Department of Surgery of the Multi-Organ Transplant Unit. Dr. Mosli is also affiliated with the Department of Medicine of King Abdulaziz University in Jeddah, Saudi Arabia. Dr. Qumosani is also affiliated with the Department of Medicine of King Fahad University Hospital of the University of Dammam in Dammam, Saudi Arabia. Dr. Al-judaibi is also affiliated with the Department of Medicine of King Khalid University Hospital of the King Saud University in Riyadh, Saudi Arabia.
Mahmoud
M
Mosli
Kristopher
K
Croome
Karim
K
Qumosani
Bandar
B
Al-Judaibi
Melanie
M
Beaton
Paul
P
Marotta
Natasha
N
Chandok
Inflammatory bowel disease; liver transplantation; predictors of outcome; primary sclerosing cholangitis