This article is more than 5 years old. Information may no longer be current.

Infliximab, corticosteroids linked to worse IBD after liver transplant

LAS VEGAS — Most patients with IBD who underwent liver transplant had stable IBD postsurgery, but use of certain maintenance therapies was associated with worsened symptoms, according to information presented this week at the 2012 American College of Gastroenterology Annual Scientific Meeting.

Researchers performed a retrospective analysis of 105 patients with IBD who received liver transplant to treat primary sclerosing cholangitis (PSC). IBD activity, as measured by symptomatology and endoscopy results, was recorded, along with incidence of mortality and development of colorectal cancer or small bowel lymphoma, during a mean follow-up of 88.5 months.

Mahmoud Mosli

“I had noticed during my training at Western University, London Health Science Centre that most of the patients seen in the transplant clinic postoperatively with PSC and concomitant IBD had well-controlled disease,” researcher Mahmoud Mosli, MBBS, FRCPC, Western University in London, Canada, told Healio.com. “I wanted to scientifically approach this interesting observation with a clinical study.”

IBD had been diagnosed before transplant in 27 patients. After the procedure, four of these patients experienced clinical improvement to their IBD, while 14 had stable disease and nine experienced worsening symptoms. Colorectal cancer developed in two patients, and small bowel lymphoma occurred in one case. Stable or improved IBD was associated with a lack of maintenance therapy, apart from anti-rejection immunosuppression, after transplant (P=.033).

Investigators observed an association between worsening IBD and the use of infliximab (P=.006) or corticosteroids (P=.006) as treatment for IBD symptoms after transplant. No association was observed between worse IBD control and maintenance therapy with 5-aminosalicylic acid agents before transplant (P=.081), or the use of cyclosporine or cyclosporine/MMF after the procedure (P=.056).

“The majority of patients with IBD and PSC who undergo liver transplantation have a stable clinical course following transplantation with regards to their IBD control,” Mosli said. “We included patients with either ulcerative colitis or Crohn’s disease, and both groups did similarly well postoperatively. Our analysis also revealed that being off any additional maintenance therapy apart from the antirejection immunosuppression regimen was associated with stable or improved disease activity post-[transplant].”

For more information:

Mosli M. P402: The Effect of Liver Transplantation for Primary Sclerosing Cholangitis on Disease Activity in Patients with Inflammatory Bowel Disease. Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting, Oct. 19-24, Las Vegas.