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P140 Use of vedolizumab in a transplanted liver patient: a case report of the first experience in a liver transplant referral center in Argentina

Daffra P.R.*1, Etchevers M.J.1, Sobrero M.J.1, Gonzalez Sueyro R.C.1, Rainero G.2, Carbonnel F.3, Vaysse T.3, Marcolongo M.M.1, De Paula J.A.1

1Hospital Italiano de Buenos Aires, Gastroenterology, Buenos Aires, Argentina 2Hospital Austral, Gatroenterology, Buenos Aires, Argentina 3CHU Bicêtre, Department of Gastroenterology, Le Kremlin-Bicêtre, France

Background

Vedolizumab is a humanized monoclonal antibody directed against the α4β7 integrin and it is indicated for induction and maintenance of remission of moderate to severe inflammatory bowel disease (IBD), either naive or refractory to anti TNF agents. Little is known about the use of Vedoluzimab in patients with liver transplantation.

Methods

We report the first patient with IBD and liver transplantation being treated with vedolizumab in a liver transplant referral center in Latin America.

Results

A 20-year-old male with a history of ulcerative colitis (UC) and primary sclerosing cholangitis, both diagnosed in the childhood, referred for liver transplantation in May 2012 to our hospital. He had a pancolitis since he was 6 month old treated with mesalamine, with frequent relapses and treatments with corticosteroids. He presented a flare-up of severe active colitis in September 2015 in France that required treatment with infliximab, with lost of response after 2 months. He was switched to vedolizumab in December 2015 with a positive clinical and endoscopic response. His blood tests done previously and after the vedolizumab infusion showed an improvement of inflammatory parameters and stability of the liver enzymes. In April 2016, he returned to Argentina and a control colonoscopy was performed showing remission of UC (Mayo score 1). So far he is still receiving vedolizumab through an especial regimen of compassionate use, because this drug has not been approved yet by the local health authorities.

Conclusion

Little is known about the use of vedolizumab in liver transplantation patients. A case series of 10 pre and/or post liver transplantation patients has recently been published showing that vedolizumab was well tolerated. In our experience we conclude that vedolizumab could be a safe option for treating refractory ulcerative colitis in liver transplant patients. More experience is needed to determine the efficacy and safety of this drug in these particulary complex group of patients.