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Zusammenfassung:
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.
