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P270. Infliximab in patients with ulcerative colitis and primary sclerosing cholangitis before and after liver transplatation

A. Indriolo1, S. Fagiuoli2, L. Pasulo2, A. Sonzogni3, M. Colledan4, G. Fiorino5, S. Danese5, P. Ravelli1

1Ospedali Riuniti of Bergamo, Gastroenterology and Digestive Endoscopy, Bergamo, Italy; 2Ospedali Riuniti of Bergamo, Gastroenterology, Bergamo, Italy; 3Ospedali Riuniti of Bergamo, Anatomy and Pathology, Bergamo, Italy; 4Ospedali Riuniti of Bergamo, Surgery and Liver Transplant Center, Bergamo, Italy; 5Istituto Clinico Humanitas, Gastroenterology, Rozzano, Italy

Background: 70% of patients with Primary Sclerosing Cholangitis (PSC) have a concomitant inflammatory bowel disease (IBD), primarily Ulcerative Colitis (UC). In patients with UC who undergo liver transplantation (LT) for PSC, the course of colonic disease activity is variable. To date, only one case has been reported for the treatment of relapsing UC following hepatic transplantation with infliximab (IFX).

The aim of the study is evaluate the clinical/endoscopic efficacy of IFX therapy and related- complications in patients with IBD and PSC, before and after LT.

Methods: A total of 373 patients with IBD and 55 patients with PSC were evaluated in our Centre from January 2001-October 2011. Both IBD and PSC was present in 29/377 (7.6%). 13/29 (44.8%) of IBD/PSC patients underwent LT for the advanced-stage of hepatic disease. Mild or quiescent UC was observed in 24/29 (82.7%) of IBD/PSC patients. Moderate-to-Severe UC or chronic steroid-refractory pouchitis (P) was present in 5/29 (17.2%) of patients. These 5 patients were treated with IFX (5 mg/Kg, 0–2‑6 weeks and every 8 weeks) for an average 18 months (range, 12–30). The efficacy of IFX treatment has been evaluated with Harvey–Bradshaw Index, Mayo Clinic Endoscopic Score Index, and Pouchitis Disease Activity Index (PDAI). The complications during IFX therapy have been reported. Hepatic reject was evaluated by liver biochemical tests and liver biopsy.

Results: Clinical and endoscopic remission, complications and hepatic reject were reported in the Table.

Results of infliximab therapy in patients with UC and PSC before and after Liver Transplantation
PatientLT (year)PUC(month)Clinic responseEndo responseComplicationHepatic reject
Before LT
Case 1 (50 ys, M)NoYes-23RemissionYesNoNo
Case 2 (27 ys, F)WaitYes-13PartialNoHerpes genitalisNo
After LT
Case 3 (27 ys, M)24-Yes30RemissionYesMollusc. contagNo
Case 4 (47 ys, M)43-Yes12RemissionWait endoNoNo
Case 5 (53 ys, M)45Yes-12RemissionNoCholangitisNo

Conclusions: In our study 17% of PSC/IBD patients present a Moderate-to-Severe UC or chronic steroid-refractory P. In these patients IFX resulted as a efficacy treatment. Only mild infections were observed during therapy before and after LT. No complications of hepatic graft function or reject were observed.

However, a large study IFX in IBD/PSC patients following LT is necessary to demonstrate our finding.