P666 Safety of combination biologic and immunosuppressive therapy post-orthotopic liver transplantation in patients with inflammatory bowel disease: a systematic review
S. Al Draiweesh*1,2, C. Ma1,3, M. Alkhattabi1,4, T. Nguyen5, M. Brahmania1, V. Jairath1,6
1Western University, Department of Medicine, Division of Gastroenterology, London, Ontario, Canada, 2King Fahad Specialist Hospital, Department of Medicine, Division of Gastroenterology, Dammam, Saudi Arabia, 3University of Calgary, Division of Gastroenterology and Hepatology, Calgary, Alberta, Canada, 4King Abdulaziz University, Department of Medicine, Rabigh, Saudi Arabia, 5Robarts Clinical Trials, Inc., London, Ontario, Canada, 6Western University, Department of Epidemiology and Biostatistics, London, Ontario, Canada
inflammatory bowel disease (IBD) patients post orthotopic liver transplantation (OLT) often have ongoing mucosal inflammation necessitating biologic agents for therapy. The safety of combined biologic and immunosuppressive therapy post-OLT in this population is unclear. The aim of this study was to systematically review the evidence for safety of combination biologic and immunosuppressive therapy in patients with Primary sclerosing cholangitis (PSC)/other liver diseases and concomitant IBD after OLT.
EMBASE, Medline, Cochrane CENTRAL, clinialtrials.gov, and the International Clinical Trials Registry Platform were searched without language restriction using keywords identifying OLT and IBD up to 1 March 2018. All studies evaluating the safety of combined biologic and anti-rejection therapy were included. All eligible studies were reviewed for safety outcomes, including infections, cancers, death, and colectomy rate. Meta-analysis was not performed due to the low quality of evidence available.
A total of 2713 citations were identified: 2315 articles were screened after removal of duplicates (
Post-OLT IBD patients receiving anti-TNF therapy are at an increased risk of enteric and postoperative infectious complications. Enteric infections should be actively screened for in patients experiencing worsening IBD symptoms.