A Case Series of De Novo Inflammatory Bowel Disease After Kidney Transplantation

Azevedo, Pedro; Freitas, Cristina; Aguiar, Pedro; Silva, H.; Santos, Teresa; Farrajota, Pedro; Almeida, Manuela; Pedroso, Sofía; Martins, La Salete; Dias, Leonídio; Vizcaíno, José R.; Henriques, António Castro; Cabrita, António

doi:10.1016/j.transproceed.2013.03.008

Cited by 12 publications

(6 citation statements)

References 26 publications

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“…In a cohort of 940 kidney transplant recipients, Dobies et al[ 25 ] found an IBD in 7 patients (0.7%). An additional case of de novo CD was recently reported by Motté et al[ 19 ], making for a total of 46 de novo histologically proven IBD cases (23 UC cases and 21 CD cases, plus 2 cases not otherwise specified) reported to date in kidney transplant recipients[ 5 , 15 , 19 , 20 , 22 - 34 ], including three paediatric patients[ 18 , 32 ]. In contrast, MMF-related colitis has a higher incidence, since it is present in up to 47% of patients undergoing colonoscopy for chronic diarrhoea[ 5 , 13 , 25 , 35 ].…”

Section: Epidemiology and Pathogenesis Of Gastrointestinal Complicatimentioning

confidence: 99%

“…Post-transplant de novo IBDs present more frequently in males, with a mean age of 35 years[ 5 , 15 , 18 , 21 , 22 , 26 - 35 ]. The main presenting symptoms are diarrhoea, abdominal pain and bright red haematochezia[ 5 , 15 , 18 , 21 , 22 , 26 - 34 ], and the mean time after transplantation to IBD presentation is 4.6 years[ 5 , 15 , 19 , 20 , 22 - 31 ]. Only in one patient did IBD present early, within one year after transplantation[ 18 ].…”

Section: Epidemiology and Pathogenesis Of Gastrointestinal Complicatimentioning

confidence: 99%

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Gastrointestinal complications after kidney transplantation

Gioco

Corona

Ekser

et al. 2020

WJG

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Gastrointestinal complications are common after renal transplantation, and they have a wide clinical spectrum, varying from diarrhoea to post-transplant inflammatory bowel disease (IBD). Chronic immunosuppression may increase the risk of post-transplant infection and medication-related injury and may also be responsible for IBD in kidney transplant re-cipients despite immunosuppression. Differentiating the various forms of post-transplant colitis is challenging, since most have similar clinical and histological features. Drug-related colitis are the most frequently encountered colitis after kidney transplantation, particularly those related to the chronic use of mycophenolate mofetil, while de novo IBDs are quite rare. This review will explore colitis after kidney transplantation, with a particular focus on different clinical and histological features, attempting to clearly identify the right treatment, thereby improving the final outcome of patients.

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Section: Epidemiology and Pathogenesis Of Gastrointestinal Complicatimentioning

confidence: 99%

Section: Epidemiology and Pathogenesis Of Gastrointestinal Complicatimentioning

confidence: 99%

Gastrointestinal complications after kidney transplantation

Gioco

Corona

Ekser

et al. 2020

WJG

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“…Among these IBD patients, one third (31%) showed improvement of IBD activity after LTx, 39% of patients displayed no significant change of IBD activity, whereas in 30% of patients the IBD activity worsened after LTx with need for treatment intensification after LTx [ 5 ]. Similarly, after renal transplantation, approximately 30% of patients develop IBD flares and one fifth of patients have to undergo colectomy after renal transplantation [ 32 – 35 ]. Therefore, for approximately one third of IBD patients treatment has to be adapted due to the increasing activity of IBD after SOT.…”

Section: Introductionmentioning

confidence: 99%

Solid Organ Transplantation in Patients with Inflammatory Bowel Diseases (IBD): Analysis of Transplantation Outcome and IBD Activity in a Large Single Center Cohort

et al. 2015

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BackgroundCurrently, 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.MethodsClinical 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.Results4.74% 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%).ConclusionsSOT 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.

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“…7,62,96,143 It is well-known from the solid organ transplant experience that calcineurin inhibitor-based immunosuppression is associated with increased risk of recurrent and de novo inflammatory bowel disease and autoimmune liver disorders. [144][145][146][147] Of the incriminating pathogenic pathways for both CD development and destructive alloimmunity, is impaired innate immunity with Paneth cell dysfunction due to different genetic mutations including NOD1 and NOD2 genes. 36,[133][134][135][148][149][150][151][152][153][154][155][156][157][158] It remains to be seen if inclusion of the donor liver with the intestinal allograft will have a long-term protective effect on disease recurrence similar to what has been documented with alloimmunity.…”

Section: Disease Recurrencementioning

confidence: 99%

Management of Crohnʼs Disease in the New Era of Gut Rehabilitation and Intestinal Transplantation

Nyabanga

Kochhar

Costa

et al. 2016

Inflammatory Bowel Diseases

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Despite recent therapeutic advances, patients with Crohn's disease (CD) continue to experience high recurrence with cumulative structural damage and ultimate loss of nutritional autonomy. With short bowel syndrome, strictures, and enteric fistulae being the underlying pathology, CD is the second common indication for home parenteral nutrition (HPN). With development of intestinal failure, nutritional management including HPN is required as a rescue therapy. Unfortunately, some patients do not escape the HPN-associated complications. Therefore, the concept of gut rehabilitation has evolved as part of the algorithmic management of these patients, with transplantation being the ultimate life-saving therapy. With type 2 intestinal failure, comprehensive rehabilitative measures including nutritional care, pharmacologic manipulation, autologous reconstruction, and bowel lengthening is often successful, particularly in patients with quiescent disease. With type 3 intestinal failure, transplantation is the only life-saving treatment for patients with HPN failure and intractable disease. With CD being the second common indication for transplantation in adults, survival outcome continues to improve because of surgical innovation, novel immunosuppression, and better postoperative care. Despite being a rescue therapy, the procedure has achieved survival rates similar to other solid organs, and comparable to those who continue to receive HPN therapy. With similar technical, immunologic, and infectious complications, survival is similar in the CD and non-CD recipients. Full nutritional autonomy is achievable in most survivors with better quality of life and long-term cost-effectiveness. CD recurrence is rare with no impact on graft function. Further progress is anticipated with new insights into the pathogenesis of CD and mechanisms of transplant tolerance.

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A Case Series of De Novo Inflammatory Bowel Disease After Kidney Transplantation

Cited by 12 publications

References 26 publications

Gastrointestinal complications after kidney transplantation

Gastrointestinal complications after kidney transplantation

Solid Organ Transplantation in Patients with Inflammatory Bowel Diseases (IBD): Analysis of Transplantation Outcome and IBD Activity in a Large Single Center Cohort

Management of Crohnʼs Disease in the New Era of Gut Rehabilitation and Intestinal Transplantation

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