Non-hepatic Solid Organ Transplant in Patients with Inflammatory Bowel Disease: An ECCO CONFER Multicentre Case Series

Author:

Ribaldone Davide Giuseppe1ORCID,Vieujean Sophie2ORCID,Julsgaard Mette3ORCID,Armandi Angelo1,Zingone Fabiana4,Savarino Edoardo4,Cañete Fiorella56,Aratari Annalisa7,Imperatore Nicola8ORCID,Ramos Laura9ORCID,Plaza Rocio10,Pugliese Daniela11,Barberio Brigida4,Drobne David1213ORCID,Chaparro María14ORCID

Affiliation:

1. Department of Medical Sciences, Division of Gastroenterology, University of Turin , Turin , Italy

2. Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège , Liège , Belgium

3. Department of Hepatology and Gastroenterology, Aarhus University Hospital , Aarhus , Denmark

4. Department of Surgery Oncology and Gastroenterology, University of Padova , Padova , Italy

5. IBD Unit. Hospital Universitari Germans Trias i Pujol , Badalona , Spain

6. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas , Madrid , Spain

7. IBD Unit, San Filippo Neri Hospital , Rome , Italy

8. Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli of Naples , Naples , Italy

9. Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna , Tenerife , Spain

10. Gastroenterology Department, Hospital Universitario Infanta Leonor , Vallecas, Madrid , Spain

11. CEMAD, IBD CENTER, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS , Rome , Italy

12. Department of Gastroenterology, University Medical Centre Ljubljana , Ljubljana, Slovenia

13. Medical Faculty, University of Ljubljana , Ljubljana , Slovenia

14. Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, IIS Princesa,, UAM, CIBEREHD , Madrid , Spain

Abstract

Abstract Background and Aims Solid organ transplantation, with the exception of liver, has rarely been reported in patients affected by inflammatory bowel diseases [IBD]. Methods This is an ECCO-CONFER project collecting cases of solid organ transplants [with the exclusion of liver] that were performed in IBD patients. We evaluated the change in the IBD therapy, need for bowel resection due to medically refractory IBD, or need for hospitalisation due to IBD relapse [‘severe IBD course’] before and after transplantation. Results in total, 34 organ transplantations [28 kidney, five heart, one lung] in 33 IBD patients were collected [67% male, 55% Crohn’s disease, mean age 53 ± 16 years]. The median follow-up was 4.3 years (interquartile range [IQR] 3.2–10.7); 29 patients [87.9%] were treated with tacrolimus, 25 [76%] with systemic steroids, 22 [67%] with mycophenolate mofetil, 11 [33%] with everolimus, six with cyclosporine [18%]. One patient was treated with infliximab, two patients with adalimumab, two patients with vedolizumab, one patient with ustekinumab. Overall, a severe IBD course was observed in three [9.3%] patients before transplantation and in four [11.7%] in the post-transplant setting [p = 0.26]. Three cases of cancer [excluding skin non-melanoma] [9.1%] were recorded in the post-transplantation period versus two in the pre-transplantation period [6.1%, p = 0.04]. Six patients [18.2%] died during the period of observation. No deaths were associated with IBD or complications of the transplant. Conclusions In IBD patients, solid organ transplantation does not seem to impact on the IBD severity. However, the risk of malignancy needs further investigation.

Publisher

Oxford University Press (OUP)

Subject

Gastroenterology,General Medicine

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