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

Abstract

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.

Kidney transplantation in patients with inflammatory bowel diseases ( IBD ): analysis of transplantation outcome and IBD activity

“…Kidney transplantation in an IBD patient is associated with complex medical conditions because of possible influence of IBD on the transplanted kidney, on the patients' survival because of IBD‐related complications, or possible need for additional immune suppression to prevent IBD flare ups . However, data regarding the outcome of KT in patients with IBD, and IBD course post KT, are scarce and inconclusive, and include small cohorts of patients . In this retrospective study, we evaluated kidney transplantation outcome and IBD course post kidney transplantation, in a relatively large cohort of IBD patients who underwent kidney transplantation in our center and were followed up for a median period of 5 years, in comparison with two groups: matched controls, and non‐IBD recipients with similar kidney diseases.…”

“…In an earlier study, Schnitzler et al . found in a small cohort of six kidney recipients (five of them CD) an excellent patient survival (no deaths) and graft survival (one graft loss). One possible explanation for the difference in patient survival is an older age at transplantation in our cohort.…”

“…In our cohort, in concordance with Schnitzler et al . , the IBD course post KT was excellent; most patients remained stable in remission or did not deteriorate. A possible explanation for the excellent course of IBD post KT may be the more intensive immunosuppression, based on MMF, prednisone, and tacrolimus in most patients, compared to less immunosuppression in liver transplantation recipients .…”

“…Most of the data on solid organ transplantation in IBD patients refer to liver transplantation, because of the high prevalence of primary sclerosing cholangitis . Reports on IBD patients undergoing renal transplantation are scarce and involve only a small number of patients; the largest published study, to the best of our knowledge, involves only six kidney recipients.…”

“…Reports on IBD patients undergoing renal transplantation are scarce and involve only a small number of patients; the largest published study, to the best of our knowledge, involves only six kidney recipients. .…”