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LT recipients with primary sclerosing cholangitis commonly develop de novo IBD
HONOLULU — Developing de novo inflammatory bowel disease post-transplant was common among patients who underwent liver transplant for primary sclerosing cholangitis, according to findings presented at ACG 2015.
“This was a retrospective study done at Mayo Clinic that included a study population of adult patients undergoing liver transplant for advanced primary sclerosing cholangitis between January 1, 1984 and December 31, 2012,” Mohamad A. Mouchli, MD, associate consultant at the Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, said during his plenary presentation. “We excluded all patients who had pre-liver transplant inflammatory bowel disease.”
Mohamad A. Mouchli
Mouchli and colleagues analyzed 373 patients who underwent LT for primary sclerosing cholangitis (PSC). Of these patients, 77.7% had IBD and 84 without IBD at the time of LT. The patients without IBD at time of LT ultimately formed the study cohort (mean age, 49±12 years). The median follow-up was 11.7 yrs (5.5-17.1) after LT.
Overall, 26.2% of patients (n = 22) developed de novo IBD after LT for PSC. Of these 22 patients, 20 presented with ulcerative colitis, one patient with Crohn’s disease and one patient with indeterminate colitis, according to Mouchli.
The cumulative incidence rate of de novo IBD was 5.5% at 1 year, 20.0% at 5 years and 25.4% at 10 years. The majority of patients had a mild course requiring either no therapy or only 5-aminosalicylates. Three patients required IBD-directed immunosuppression, according to Mouchli.
“Approximately 18.2% did not require treatment and four patients underwent colectomy after LT for colorectal neoplasia,” Mouchli said.
Analysis showed that mycophenolate mofetil post-LT was associated with an increased risk for de novo IBD (HR = 3.3; 95% CI, 1.3-9.5), whereas azathioprine use was associated with a decreased risk of de novo IBD (HR = 0.2; 95% CI, 0.1-0.6). Neither the recurrence of PSC in allograft or use of tacrolimus were associated with developing de novo IBD after LT.
“Transplant-related immunosuppression may modify the risk of de novo IBD,” Mouchli said. “[We should] consider de novo IBD in patients with PSC undergoing LT as a cause for diarrhea after ruling out other factors like infection and medication-induced diarrhea,” Mouchli said. – by Melinda Stevens
Reference:
Mouchli MA, et al. Abstract 3. Presented at: ACG; Oct. 16-21, 2015; Honolulu.
Disclosures: The researchers report no relevant financial disclosures.