Anti-tumour necrosis factor treatment of inflammatory bowel disease in liver transplant recipients.

Background Ulcerative colitis ( UC) and Crohn's disease can sometimes relapse and be refractory to standard treatment following orthotopic liver transplantation ( OLT) despite post-transplantation immunosuppressive therapy. Aim To evaluate the efficacy and safety of anti-tumour necrosis factor (anti- TNF) agents for the management of IBD following OLT. Methods We reviewed the records of patients with a diagnosis of IBD who underwent OLT at Mayo Clinic Rochester between 1985 and 2009. Patients were included if they had received anti- TNF therapy post- OLT. Clinical response was defined as a physician's assessment of improvement after 12 weeks of anti- TNF usage, and mucosal healing was defined as the absence of ulcerations on follow-up endoscopy. Results The median age of the eight study patients was 42.0 years and 37.5% were female patients. All had been diagnosed with IBD prior to OLT ( UC in three and Crohn's disease in five). Indication for OLT was cirrhotic stage primary sclerosing cholangitis ( PSC), and three concomitantly had cholangiocarcinoma. Clinical response was demonstrated in seven of eight patients (87.5%) and mucosal healing was demonstrated in three of seven (42.9%). Four infections (oral candidiasis, Clostridium difficile colitis, bacterial pneumonia and cryptosporidiosis) in three patients were reported. One patient developed an Epstein- Barr virus-positive post-transplant lympho-proliferative disorder. One death occurred due to complications from recurrent PSC. Conclusions Starting Anti- TNF therapy following orthotopic liver transplantation appears to be a potential option for inflammatory bowel disease management. Additional studies are needed, however, to confirm these findings and to further assess risks associated with this treatment strategy. [ABSTRACT FROM AUTHOR]