Tumor-Necrosis-Factor-α Antagonist Therapy for Inflammatory Bowel Disease After Liver Transplantation.
Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI.
Meeting: 2016 American Transplant Congress
Abstract number: C204
Keywords: Immunosuppression, Inflammation, Primary sclerosing cholangitis
Session Information
Session Name: Poster Session C: Liver Transplantation Complications and Other Considerations
Session Type: Poster Session
Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background:
The safety and effectiveness of tumor-necrosis-factor-α antagonist (anti-TNF-α) therapy for inflammatory bowel disease (IBD) has not been well-established in patients after liver transplantation (LT). We aimed to evaluate the safety and efficacy of anti-TNF-α agents in the treatment of IBD in patients after LT for primary sclerosing cholangitis (PSC).
Methods:
We performed a chart review on patients with a diagnosis of IBD who underwent LT for PSC between 1993 and 2015 at Henry Ford Hospital. Five patients received anti-TNF-α therapy after LT for treatment of IBD. Various clinical and demographic data, hospital admissions, prednisone escalation for IBD, surgeries, endoscopy findings and infectious complications were recorded.
Results:
Three males and 2 females received anti-TNF-α agents for IBD after LT. One out of the 5 patients received a living donor LT. Prior to LT, 1 patient had received an anti-TNF-α agent and the other 4 patients were treated with 5 Amino-Salicylic Acid derivatives and/or immunomodulators. Clinical response was achieved in 1 out of 5 patients. Infections were seen in 2 patients. Two patients underwent total colectomy for severe uncontrolled IBD. Two patients developed post-transplant lymphoproliferative disorder (PTLD). One patient died due to complications secondary to PTLD.
| Anti-TNF before LT | Type of IBD | Anti-TNF after LT | Imunosuppression | Infections/Complications | Surgeries | Clinical outcome | |
| 1 | No | Crohn’s | Adalimumab | Cyclosporine Mycophenolate |
Clostridium difficle colitis, esophageal candidiasis, Cytomegalovirus viremia, PTLD | Total colectomy | Death |
| 2 | No | UC | Infliximab | Tacrolimus Azathioprine | Pancytopenia | None | Active IBD |
| 3 | No | UC | Infliximab | Tacrolimus | No | None | Active IBD |
| 4 | No | UC | Infliximab | Tacrolimus | Clostridium difficle colitis | Total colectomy | Stable |
| 5 | Adalimumab | Crohn’s | Adalimumab | Tacrolimus | PTLD | None | Severely ill |
Conclusion:
In our study, anti-TNF-α agents were found to be both ineffective and unsafe in patients after LT for PSC. Rates of infection were increased when given in combination with immunosuppressive agents for LT. PTLD occurred at a greater rate in these patients. Given these complications, in patients with severe UC post LT, early colectomy should be considered rather than medical therapy. Further studies are needed to evaluate the safety and efficacy profile of these therapies in post-LT patients on a larger scale.
CITATION INFORMATION: Parekh R, Segovia M, Kaur N. Tumor-Necrosis-Factor-α Antagonist Therapy for Inflammatory Bowel Disease After Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Parekh R, Segovia M, Kaur N. Tumor-Necrosis-Factor-α Antagonist Therapy for Inflammatory Bowel Disease After Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/tumor-necrosis-factor-antagonist-therapy-for-inflammatory-bowel-disease-after-liver-transplantation/. Accessed November 21, 2024.« Back to 2016 American Transplant Congress