TY - JOUR
T1 - Natural History of Established and de Novo Inflammatory Bowel Disease after Liver Transplantation for Primary Sclerosing Cholangitis
AU - Loftus, Edward V.
AU - Mouchli, Mohamad A.
AU - Singh, Siddharth
AU - Boardman, Lisa
AU - Bruining, David H.
AU - Lightner, Amy L.
AU - Rosen, Charles B.
AU - Heimbach, Julie K.
AU - Hasan, Bashar
AU - Poterucha, John J.
AU - Watt, Kymberly D.
AU - Kane, Sunanda V.
AU - Raffals, Laura E.
N1 - Funding Information:
Supported by: We acknowledge support from National Cancer Institute (NCI) CA 170357 and the Mayo Clinic Center for Cell Signaling in Gastroenterology (NIDDK P30DK084567) and from the time Lapse NCI CA 170357. Dr. Singh is supported by the NLM training grant T15LM011271, the American College of Gastroenterology, and Crohn’s and Colitis Foundation of America, and has received research support from Pfizer.
Publisher Copyright:
© 2018 Crohn's & Colitis Foundation.
PY - 2018/4/23
Y1 - 2018/4/23
N2 - Background The course of inflammatory bowel disease (IBD) after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is poorly understood. We describe the natural history of established IBD after LT (including risk of disease progression, colectomy, and neoplasia) and de novo IBD. Methods In a retrospective cohort, we identified all patients with PSC who underwent LT for advanced PSC at Mayo Clinic, Rochester, Minnesota. Risk factors were identified using multivariate Cox proportional hazard analysis. Results Three hundred seventy-three patients were identified (mean age, 47.5 ± 11.7 years; 64.9% male). Over a median (range) of 10 (5.5-17.1) years, 151 patients with PSC-IBD with an intact colon at the time of LT were studied. Post-LT, despite transplant-related immunosuppression, 56/151 (37.1%) required escalation of therapy, whereas 87 had a stable course (57.6%) and 8 patients (5.3%) improved. The 1-, 5-, and 10-year risks of progression of IBD were 4.0%, 18.5%, and 25.5%, respectively. On multivariate analysis, tacrolimus-based immunosuppression post-LT were associated with unfavorable course, and azathioprine use after LT was associated with improved course post-LT. Of 84 patients with no evidence of IBD at the time of LT, 22 (26.2%) developed de novo IBD post-LT. The 1-, 5-, and 10-year cumulative incidences of de novo IBD were 5.5%, 20.0%, and 25.4%, respectively. On univariate analysis, mycophenolate mofetil use after LT was associated with increased risk of de novo IBD, but azathioprine use after LT seemed to be protective. Conclusions The 10-year cumulative probability of IBD flare requiring escalation of therapy after LT for PSC was 25.5%, despite immunosuppression for LT. The 10-year cumulative risk of de novo IBD after LT for PSC was 25.4%. Transplant-related immunosuppression may modify the risk of de novo IBD, with an increased risk with mycophenolate and a decreased risk with azathioprine. 10.1093/ibd/izx096-video1 izx096.video1 5746673864001.
AB - Background The course of inflammatory bowel disease (IBD) after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is poorly understood. We describe the natural history of established IBD after LT (including risk of disease progression, colectomy, and neoplasia) and de novo IBD. Methods In a retrospective cohort, we identified all patients with PSC who underwent LT for advanced PSC at Mayo Clinic, Rochester, Minnesota. Risk factors were identified using multivariate Cox proportional hazard analysis. Results Three hundred seventy-three patients were identified (mean age, 47.5 ± 11.7 years; 64.9% male). Over a median (range) of 10 (5.5-17.1) years, 151 patients with PSC-IBD with an intact colon at the time of LT were studied. Post-LT, despite transplant-related immunosuppression, 56/151 (37.1%) required escalation of therapy, whereas 87 had a stable course (57.6%) and 8 patients (5.3%) improved. The 1-, 5-, and 10-year risks of progression of IBD were 4.0%, 18.5%, and 25.5%, respectively. On multivariate analysis, tacrolimus-based immunosuppression post-LT were associated with unfavorable course, and azathioprine use after LT was associated with improved course post-LT. Of 84 patients with no evidence of IBD at the time of LT, 22 (26.2%) developed de novo IBD post-LT. The 1-, 5-, and 10-year cumulative incidences of de novo IBD were 5.5%, 20.0%, and 25.4%, respectively. On univariate analysis, mycophenolate mofetil use after LT was associated with increased risk of de novo IBD, but azathioprine use after LT seemed to be protective. Conclusions The 10-year cumulative probability of IBD flare requiring escalation of therapy after LT for PSC was 25.5%, despite immunosuppression for LT. The 10-year cumulative risk of de novo IBD after LT for PSC was 25.4%. Transplant-related immunosuppression may modify the risk of de novo IBD, with an increased risk with mycophenolate and a decreased risk with azathioprine. 10.1093/ibd/izx096-video1 izx096.video1 5746673864001.
KW - inflammatory bowel disease
KW - liver tranpslant
KW - primary sclerosing cholangitis
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U2 - 10.1093/ibd/izx096
DO - 10.1093/ibd/izx096
M3 - Article
C2 - 29522202
AN - SCOPUS:85046253994
SN - 1078-0998
VL - 24
SP - 1074
EP - 1081
JO - Inflammatory bowel diseases
JF - Inflammatory bowel diseases
IS - 5
ER -