title: De novo inflammatory bowel disease after pediatric kidney or liver transplant.
abstract: A subset of children who receive a liver and/or kidney transplant develop de novo inflammatory bowel disease-like chronic intestinal inflammation, not explained by infection or medications, following transplant. We have conducted a single-center, retrospective case series describing the unique clinical and histologic features of this IBD-like chronic intestinal inflammation following solid organ transplant. At our center, nine of 327 kidney or liver recipients developed de novo IBD following transplant (six liver, two kidney, one liver-kidney). Most children presented with prolonged hematochezia and diarrhea and were treated with aminosalicylates. At time of diagnosis, five were not currently using mycophenolate mofetil for transplant immunosuppression. Histologic and endoscopic findings at IBD diagnosis included inflammation, ulcerations, granulomas, and chronic colitis. Since diagnosis, no patients have required surgical intervention, or escalation to biologic therapy, nor developed stricturing or perianal disease. In this case series, de novo post-transplant IBD developed in 4% of pediatric liver and/or kidney recipients; however, it often does not fit the classic patterns of Crohn's disease or ulcerative colitis.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Benioff Children's Hospital San Francisco, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fernandes
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Hillary J
authors.initials: HJ
authors.lastname: Braun
authors.affiliation: Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Evason
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Benioff Children's Hospital San Francisco, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Rhee
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Benioff Children's Hospital San Francisco, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Perito
mesh_terms: D000293:Adolescent; D010131:Aminosalicylic Acid / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007249:Inflammation; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D010131:Aminosalicylic Acid
keywords: colitis; diarrhea; immunosuppression; solid organ transplant