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DE NOVO IBD OCCURING AFTER ORTHOTOPIC LIVER TRANSPLANTATION
R Tamaz, M Bouin, EG Seidman, D Marleau
BACKGROUND: Previous reports investigating the clinical course and management of inflammatory bowel disease (IBD) with onset after orthotopic liver transplant (OLT) for primary sclerosing cholangitis (PSC) have revealed conflicting results. New onset IBD may also occur after OLT without PSC despite sufficient allograft immunosuppressive therapy, and little is known about the natural history of IBD after OLT.
OBJECTIVES: To characterize the natural history and course of therapy of liver transplant patients with IBD diagnosed exclusively after OLT.
METHODS: We retrospectively reviewed the records of all patients who underwent OLT between 1984 and 2005 in one liver transplantation center. From this database we selected only patients with a newly diagnosed IBD occurring after OLT. For each patient, clinical data were collected including: age, sex, liver disease before transplantation, time interval between OLT and IBD occurrence, type of IBD, disease activity, immunosuppressive therapy used, the need for surgery and adverse reactions. Were excluded patients with any evidence of gastrointestinal infections.
RESULTS: Evaluating our database of 589 patients, we found 9 subjects who developed IBD de novo after OLT. Five males and four females presented endoscopical and histological features of IBD (3 ulcerative colitis, 6 Crohn’s disease) with a mean age at presentation of 47 years (age range: 19-62). The primary liver disease requiring transplantation varied: 2 with PSC, 4 with autoimmune hepatitis, 2 with primary biliary cirrhosis and 1 with idiopathic fulminant hepatitis. Average time between OLT and new-onset IBD was 47 months (SD, 36 months). Tacrolimus was the main allograft immunosuppressive therapy for 7/9 patients at the time the IBD was diagnosed. Overall, five patients (56 %) had an aggressive clinical course of IBD requiring anti-TNF therapy (n = 3) or surgical resection (n = 2) to control their disease. No severe infection or graft rejection was reported during the study time period.
CONCLUSION: De novo IBD can develop after OLT despite sufficient allograft immunosuppressive therapy. The prevalence of IBD in our OLT population was 1.5%. The exact pathophysiological mechanisms and predisposing genes underlying this unusual presentation of IBD remain unknown. Pre-existing autoimmune liver disease appears to be a risk factor. High level of immunosuppressive therapy is often needed to control disease activity.