P140 Use of vedolizumab in a transplanted liver patient: a case report of the first experience in a liver transplant referral center in Argentina

Daffra, Pamela R.; Etchevers, María Josefina; Sobrero, Maria J.; Sueyro, Ramiro C. Gonzalez; Rainero, German L.; Carbonnel, Franck; Vaysse, Thibaut; Marcolongo, Mariano; Paula, Juan A. De

doi:10.1093/ecco-jcc/jjx002.266

Cited by 4 publications

(4 citation statements)

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“…After the first review process of all the titles, 11 articles were considered as full text. Of these, eight studies matched the inclusion/exclusion criteria and were finally included 10–17 . All studies were published between 2016–2018.…”

Section: Resultsmentioning

confidence: 99%

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Safety of vedolizumab in liver transplant recipients: A systematic review

Spadaccini¹,

Aghemo

Caprioli

et al. 2019

UEG Journal

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Background The management of inflammatory bowel disease in patients who have previously undergone liver transplantation can be a clinical challenge. There are serious concerns among physicians regarding the use of biologics for treating such immuno-compromised patients. Objective We performed a systematic review on vedolizumab therapy in transplant recipients to assess its safety. Methods PubMed/Embase/Scopus were searched up to November 2018 to identify papers regarding liver transplant recipients and therapy with vedolizumab. Primary outcomes were adverse events. Secondary outcomes were liver transplant and inflammatory bowel disease outcomes. Results Eight studies (31 patients) were included. Nine out of 31 patients experienced an infection within a mean follow-up time ranging from 5–20 months. No malignancies were reported. Inflammatory bowel disease clinical response was experienced by 20/26 patients. Abnormalities in liver tests were recorded in 2/22 patients. Conclusion Vedolizumab may be considered safe for treating inflammatory bowel disease in liver transplant recipients. Caution is recommended for patients with an unstable liver graft function.

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Section: Resultsmentioning

confidence: 99%

“…Of these, eight studies matched the inclusion/exclusion criteria and were finally included. 10–17 All studies were published between 2016–2018. The study origins were as follows: six studies were from Europe (25 patients), and the remains were from Australia (five patients) and from Argentina (one patient).…”

Section: Resultsmentioning

confidence: 99%

Safety of vedolizumab in liver transplant recipients: A systematic review

Spadaccini¹,

Aghemo

Caprioli

et al. 2019

UEG Journal

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“…Fifteen case reports and case series exploring the efficacy and safety of various biologic agents for recurrent or de novo IBD in liver transplant recipients were identified (Table ) . From these 15 case reports, we identified 67 patients who developed de novo or recurrent IBD after liver transplantation, and who also received anti‐TNF or anti‐integrin therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen case reports and case series exploring the efficacy and safety of various biologic agents for recurrent or de novo IBD in liver transplant recipients were identified (Table 1). [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] From these 15 case reports, we identified 67 patients who developed de novo or recurrent IBD after liver transplantation, and who also received anti-TNF or anti-integrin therapy. A majority of patients received liver transplants for PSC (60 patients [89.6%]), with other indications including fulminant hepatic failure, biliary atresia, subfulminant hepatitis, autoimmune hepatitis, and autoimmune sclerosing cholangitis.…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Safety and Efficacy of Biologic Agents for the Management of Inflammatory Bowel Disease After Liver Transplantation

2017

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Primary sclerosing cholangitis (PSC) frequently progresses to end-stage liver disease and cirrhosis, requiring liver transplantation. Approximately 70% of patients with PSC have concomitant inflammatory bowel disease (IBD) during their clinical course. After liver transplantation for PSC, corticosteroids and other high-intensity immunosuppressants are initiated to keep IBD in remission. Patients with IBD that is refractory to these agents may need to be managed with biologic therapies. Biologic agents, however, may further increase the risks for malignancy and infection due to their immunosuppressive effects. Thus, to gain a better understanding of the risks and benefits of these agents in this high-risk patient population, we performed a literature search of the PubMed database (2002-2017) to identify studies assessing the efficacy and safety of various biologic agents for the management of IBD in liver transplant recipients. No randomized controlled studies or retrospective comparative studies were identified; however, 15 case reports and case series were identified that met our inclusion criteria. From these case reports, we identified 67 patients who developed de novo or recurrent IBD after liver transplantation and received anti-tumor necrosis factor-α or anti-integrin therapy. Of the 13 published cases reporting clinical response or remission of IBD activity in liver transplant recipients (59 patients), clinical response or remission of IBD was reported in 38 (64.4%) of those patients. Adverse complications reported included cholangitis, oral candidiasis, Clostridium difficile colitis, bacterial pneumonia, cryptosporidiosis, Epstein-Barr virus-positive posttransplantation lymphoproliferative disease, and hepatotoxicity. Given the limited literature (case reports and case series) highlighted in this review, biologic agents such as tumor necrosis factor-α inhibitors and integrin inhibitors commonly used for moderate to severe IBD may be appropriate after liver transplantation; however, consideration of risk versus benefit should always occur in a patient-specific manner.

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