The impact of inflammatory bowel disease post‐liver transplantation for primary sclerosing cholangitis

Joshi, Deepak; Bjarnason, Ingvar; Belgaumkar, Ajay; O’Grady, John; Suddle, Abid; Heneghan, Michael A.; Aluvihare, Varuna; Rela, Mohammed; Heaton, Nigel; Agarwal, Kosh

doi:10.1111/j.1478-3231.2011.02677.x

Cited by 75 publications

(50 citation statements)

References 32 publications

(50 reference statements)

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“…Three different patterns of the disease courses were almost equally distributed across the patients: 31% improved, 39% were stable and 30% worsened. After 5 and 10 years, the cumulative risks of disease exacerbation were 39%-63% and 39%-98%, respectively[37,38]. …”

Section: Risk Factors Associated With Exacerbation or De Novo Ibd Aftmentioning

confidence: 99%

“…At the moment, it is not possible to correlate age, gender, duration or severity of PSC disease, the extent and type of IBD (UC or CD), or pre-transplant IBD treatment (immunomodulator or corticosteroids) with the upcoming post-transplant clinical IBD course[34,35,37,38,39,40]. Verdonk et al[41] reported that clinically active IBD at the time of LT is related to a threefold higher risk for a post-transplant IBD flare up.…”

Section: Risk Factors Associated With Exacerbation or De Novo Ibd Aftmentioning

confidence: 99%

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Inflammatory bowel disease in liver transplanted patients

Kanižaj

Mijić

2017

WJG

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Most common hepatobiliary manifestation of inflammatory bowel disease (IBD) are primary sclerosing cholangitis (PSC) and autoimmune hepatitis, ranking them as the main cause of liver transplantation (LT) in IBD setting. Course of pre-existing IBD after LT differs depending on many transplant related factors. Potential risk factors related to IBD deterioration after LT are tacrolimus-based immunosuppressive regimens, active IBD and cessation of 5-aminosalicylates at the time of LT. About 30% patients experience improvement of IBD after LT, while approximately the same percentage of patients worsens. Occurrence of de novo IBD may develop in 14%-30% of patients with PSC. Recommended IBD therapy after LT is equivalent to recommendations to overall IBD patients. Anti-tumor necrosis factor alpha appears to be efficient for refractory IBD. Due to potential side effects it needs to be applied with caution. In average 9% of patients require proctocolectomy due to medically refractory IBD or colorectal carcinoma. The most frequent complication in patients who undergo proctocolectomy with ileal-pouch anal anastomosis is pouchitis. It is still undeterminable if LT adds to risk of developing pouchitis in PSC patients. Annual colonoscopies are recommended as surveillance and precaution of colonic malignancies.

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Section: Risk Factors Associated With Exacerbation or De Novo Ibd Aftmentioning

confidence: 99%

Section: Risk Factors Associated With Exacerbation or De Novo Ibd Aftmentioning

confidence: 99%

Inflammatory bowel disease in liver transplanted patients

Kanižaj

Mijić

2017

WJG

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“…Steroids, Azathioprine and Cyclosporine should be preferred in these subgroup of patients [94,193,[199][200][201]. The therapeutic response and outcome is usually poor when compared to the de novo IBD patients; requiring colectomy for refractory bowel disease [197,199,200]. Conflicting evidence suggesting for and against the association of use of immunosuppressive agents and CRC have been published [202,203].…”

Section: Ibd and Liver Transplantationmentioning

confidence: 99%

“…Risk factors for worsening of preexisting IBD after liver transplant includes active bowel inflammation at the time of transplantation [193], short interval between diagnosis of IBD and transplant [193], cigarette smoking [197], Clostridium difficile infection [198] and use of Tacrolimus after transplant [191,193,199,200]. The use of steroid or immunosuppressive agents prior to transplant does not predict post-transplant IBD activity [194,195].…”

Section: Ibd and Liver Transplantationmentioning

confidence: 99%

A review of liver disorders in inflammatory bowel disease (IBD)

Shah¹,

Gupta²,

Borg³

2017

Clin Case Rep Rev

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Disorders of the liver and the biliary tract are frequently the extraintestinal manifestations of inflammatory bowel disease (IBD). The etiology of these hepato-biliary conditions is deemed secondary to their shared pathogenesis, the chronic effects of a long term, ongoing inflammation of the bowels, along with the medications used to manage IBD. For up to 30% of patients with IBD, abnormal liver biochemical tests are present. Other, selected patients with IBD are followed for reactivation of hepatitis B, through guidelines only relatively recently in place. The vast realm of related clinical conditions does not always correspond well with IBD severity, which can range from mild hepatic insult to end-stage liver disease, necessitating liver transplantation. Hence it is critical to follow its presence, clinical course and long term consequences. Moreover, the management of these disorders is necessarily individualized, with some patients requiring frequent monitoring and others a more multi-disciplinary approach. Studies aimed at improving the outcomes of patients with IBD who experience associated liver and biliary tract disorders are now needed to assess early identification, possible screening approaches and more effective systems of referral. This article covers the evidence-based literature on topics detailing the co-existence of liver conditions in inflammatory bowel disease with a focus on its epidemiology, clinical manifestations, diagnosis and management.

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“…1 The few published case series on antitumor necrosis factor a (anti-TNF-a) use suggest a high efficacy rate. [2][3][4] Reviewing our prospectively kept IBD database, we identified 6 patients (median age, 49 years; range, 32-64 years) who required anti-TNF-a therapy for active, steroid-dependent pancolitis (5/6) or refractory pouchitis (1/6) at 5 years (range, 2-12 years) after LT. Concomitant immunosuppression included tacrolimus (6/6), mycophenolate mofetil (1/6), azathioprine (1/6), and prednisolone (3/6).…”

mentioning

confidence: 99%