P472. Infliximab therapy for inflammatory bowel disease in patients post liver transplatation
A. Indriolo1, S. Fagiuoli2, L. Pasulo2, G. Fiorino3, S. Danese3, P. Ravelli1, 1Ospedali Riuniti di Bergamo, Gastroenterology and Digestive Endoscopy Unit II, Bergamo, Italy, 2Ospedali Riuniti di Bergamo, Gastroenterology I and Liver Transplantation Unit, Bergamo, Italy, 3IRCSS Umanitas, IBD Center, Gastroenterology, Rozzano, Italy
From 54% to 90% of PSC patients develop IBD. 5% of patients with Ulcerative Colitis (UC) associated to Primary Sclerosing Cholangitis (PSC). To date, a few studies with a case report or serial cases have been reported for the treatment of refractory IBD following liver transplantation with anti-TNFalfa.
The aim of this study is to evaluate the clinical and endoscopic efficacy, and safety of infliximab therapy for UC following liver transplantation in patients with PSC.
We evaluated all patients clear diagnosis of UC who underwent Orthotopic Liver Transplantation (OLT) at Ospedali Riuniti of Bergamo between January 2001 and September 2012 and who had received inflixamab therapy for refractory IBD following liver transplantation.
Four patients (all men; median age 39 years, range 22–54 years) with UC (3) and pouchitis (1) who underwent OLT were identified. Three patients (75%) experienced sustained improvement of IBD. Mucosal healing was observed in one of three patients (33%). Steroid treatment was interrupted during infiximab therapy in all patients. Adverse events included only one infection: molluscum contagiosum on face of one patient, treated with laser-therapy with resolution of symptoms. No malignancies were observed in all patients following infliximab therapy. No hepatic reject was documented while on infliximab therapy. One patient 25%) presented a recurrence of PSC two years before infliximab therapy (three years after OLT) and he underwent a second OLT after 5 years after the first.
Infliximab therapy appears to be effective in patients with refractory ulcerative colitis after liver transplantation. Although no complications of hepatic graft function or reject were observed, additional largest studies are need to evaluate the safety's profile of biological therapy combined to anti-reject treatment in patients with refractory IBD following liver transplantation.