Solid Organ Transplantation in Patients with Inflammatory Bowel Diseases (IBD): Analysis of Transplantation Outcome and IBD Activity in a Large Single Center Cohort.
BACKGROUND
Currently, limited data of the outcome of inflammatory bowel disease (IBD) in patients after solid organ transplantation (SOT) are available. We aimed to analyze effects of SOT on the IBD course in a large IBD patient cohort.


METHODS
Clinical data from 1537 IBD patients were analyzed for patients who underwent SOT (n = 31) between July 2002 and May 2014. Sub-analyses included SOT outcome parameters, IBD activity before and after SOT, and efficacy of IBD treatment.


RESULTS
4.74% of patients with ulcerative colitis (UC) and 0.84% of patients with Crohn's disease (CD) underwent SOT (p = 2.69 x 10(-6), UC vs. CD). 77.4% of patients with SOT underwent liver transplantation (LTx) with tacrolimus-based immunosuppressive therapy after SOT. All LTx were due to primary sclerosing cholangitis (PSC) or PSC overlap syndromes. Six patients (19.4%) required renal transplantation and one patient (3.2%) heart transplantation. A survival rate of 83.9% after a median follow-up period of 103 months was observed. Before SOT, 65.0% of patients were in clinical remission and 5 patients received immunosuppressive therapy (16.1%). After SOT, 61.0% of patients were in remission (p = 1.00 vs. before SOT) and 29.0% required IBD-specific immunosuppressive or anti-TNF therapy (p = 0.54 vs. before SOT). 42.9% of patients with worsening of IBD after SOT were at higher risk of needing steroid therapy for increased IBD activity (p = 0.03; relative risk (RR): 10.29; 95% CI 1.26-84.06). Four patients (13.0%) needed anti-TNF therapy after SOT (response rate 75%).


CONCLUSIONS
SOT was more common in UC patients due to the higher prevalence of PSC-related liver cirrhosis in UC. Despite mainly tacrolimus-based immunosuppressive regimens, outcome of SOT and IBD was excellent in this cohort. In this SOT cohort, concomitant immunosuppressive therapy due to IBD was well tolerated.
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Fabian
F
Schnitzler
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany; Department of Preventive Dentistry and Periodontology, Ludwig-Maximilians-University (LMU), Munich, Germany.
Matthias
M
Friedrich
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Johannes
J
Stallhofer
Department of Medicine IV Nephrology-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Ulf
U
Schönermarck
Department of Medicine IV Nephrology-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany; Transplantation Center-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Michael
M
Fischereder
Transplantation Center-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Antje
A
Habicht
Max-Planck-Institute of Psychiatry, Munich, Germany.
Nazanin
N
Karbalai
Max-Planck-Institute of Psychiatry, Munich, Germany.
Christiane
C
Wolf
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Marianne
M
Angelberger
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Torsten
T
Olszak
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Florian
F
Beigel
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Cornelia
C
Tillack
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Burkhard
B
Göke
Transplantation Center-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Reinhart
R
Zachoval
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany; Transplantation Center-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Gerald
G
Denk
Transplantation Center-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany; Department of Surgery-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Markus
M
Guba
Department of Gastroenterology, Hospital Barmherzige Brüder, Munich, Germany.
Christian
C
Rust
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany; Transplantation Center-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Norbert
N
Grüner
Department of Medicine II-Grosshadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
Stephan
S
Brand
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D016559:Tacrolimus