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

PLoS One. 2015 Aug 19;10(8):e0135807. doi: 10.1371/journal.pone.0135807. eCollection 2015.

Abstract

Background: Currently, 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.

Methods: Clinical 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.

Results: 4.74% 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%).

Conclusions: SOT 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Colitis, Ulcerative / drug therapy*
  • Colitis, Ulcerative / pathology
  • Crohn Disease / drug therapy*
  • Crohn Disease / pathology
  • Female
  • Heart Transplantation / adverse effects*
  • Humans
  • Immunosuppression Therapy
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation / adverse effects*
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Survival Rate
  • Tacrolimus / therapeutic use
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Tacrolimus

Grants and funding

S. Brand was supported by grants from the Deutsche Forschungsgemeinschaft (DFG) (BR1912/6-1) and the Else-Kröner-Fresenius-Stiftung (Else Kröner-Exzellenzstipendium 2010_EKES.32). F. Beigel was supported by DFG (BE 4490/2-1). C. Tillack was supported by a grant of Ludwig-Maximilians-University Munich (FöFoLe program). T. Olszak was supported by a grant from Deutsche Forschungsgemeinschaft (DFG, OL/324-1) and by a grant from the Ludwig-Maximilians-University Munich (FöFoLe program). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.