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P219. Solid organ transplantation and inflammatory bowel disease (IBD)

P. Martínez, B. Casis, G.J. Gómez, F. Sánchez, A. Manrique, F. Colina, G. Castellano

Hospital 12 de Octubre, Madrid, Spain

Aims: (1) To evaluate the influence of transplant immunosuppression in IBD. (2) To analyze the effect of IBD treatment on the graft. (3) To study immunosuppression-related infections.

Patients and Methods: Retrospective study in a single center. All patients with IBD and solid organ transplantation, in our IBD Unit, since 1986 to 2010 were included. Patients who died in the first year after transplantation were excluded. We included IBD patients using Montreal classification, taking into account the type of transplant, development of de novo disease as well as the exacerbation of pre-existent IBD and immunosupression to prevent rejection, course of IBD before and after transplantation, the changes in immunosuppression determined by the course of IBD and its influence on the graft (reject or infection).

Results: 11 patients were included: eight Crohn's disease (CD), two ulcerative colitis (CU) and one unclassified colitis (UN). Seven of them had received liver transplantation, two renal, one cardiac and one bowel transplant. Six patients had previously suffered from IBD, in remission at the time of transplantation. Despite immunosuppression for transplant, IBD course was aggressive in 50%, three of them required biological therapy (two due to severe fistulizing disease and one by inflammatory stenosis). Five patients (45%) developed IBD de novo. Two of them were transplanted for primary sclerosing cholangitis (CEP) and another one by hepatic cirrhosis due to an overlap syndrome (autoimmune hepatitis/primary biliary cirrhosis). IBD course after transplantation was aggressive in three patients (60%) and they needed biological therapy to control IBD for severe inflammatory disease; another patient underwent surgery for secondary intestinal obstruction to ileal stenosis. Only one was controlled with mesalazine. None of them had Cytomegalovirus (CMV) infection after transplant as a risk factor for developing IBD. All, except one, were treated with tacrolimus. Biological therapy did not increase rejection or infection.

Conclusions: (1) Transplant immunosuppression did not prevent recurrence or de novo appearance of IBD. (2) As it has been suggested by previous studies, tacrolimus can be a factor of bad prognosis in the recurrence of IBD in post-transplants. (3) The course of the IBD in post-transplant, previous or de novo, was more aggressive without finding any influence of CMV infections in our patients. (4) Biological therapy was not related with rejection or with the increase of opportunistic infections in these patients.