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DOP04 Inflammatory Bowel Disease (IBD) and Solid Organ Transplantation. Natural history of pre-existing and de novo IBD patients. (EITOS study of GETECCU)

Bastón Rey, I.(1);Calvino Suárez, C.(1);Luque, A.M.(2);Caballol, B.(3);Soutullo, C.(4);Bravo, A.(5);Castaño, A.(6);Gros, B.(7);Bernal, L.(8);Diz Lois, M.T.(9);Alonso Galán, H.(10);Cañete, F.(11);Castro, B.(12);Pérez Galindo, P.(13);González Muñoza, C.(14);El Hajra, I.(15);Martínez Montiel , P.(16);Alonso Abreu, I.(17);Mesonero, F.(18);González Vivo, M.(19);Peries, L.(20);Martín Arranz, E.(21);Abril, C.(22);Marín Jiménez, I.(23);Baltar, R.(24);Vicuna, M.(25);Moreno, N.(26);Brunet, E.(27);Rubín de Célix, C.(28);Fajardo, I.(29);Cruz, N.(30);Rojas Feria, M.(2);Fernández Clotet, A.(3);Gimeno, M.(4);Zabana, Y.(31);Suárez Ferrer, C.(21);Rodríguez Lago, I.(32);Barreiro de Acosta, M.(1);

(1)Hospital Clínico Universitario de Santiago De Compostela, Gastroenterology Department, Santiago De Compostela, Spain;(2)Hospital Universitario Virgen del Rocío, Gastroenterology Department, Sevilla, Spain;(3)Hospital Clinic de Barcelona, Gastroenterology Department, Barcelona, Spain;(4)Hospital Universitario y Politécnico La Fe, Gastroenterology Department, Valencia, Spain;(5)Hospital Regional Universitario de Málaga, Gastroenterology Department, Málaga, Spain;(6)Hospital Universitario Central de Asturias, Gastroenterology Department, Oviedo, Spain;(7)Hospital Universitario Reina Sofía, Gastroenterology Department, Córdoba, Spain;(8)Hospital General de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, Gastroenterology Department, Alicante, Spain;(9)Complexo Hospitalario Universitario A Coruña, Gastroenterology Department, A Coruña, Spain;(10)Hospital Universitario Donostia and Biodonostia Health Research Institute, Gastroenterology Department, San Sebastián- Gipuzkoa, Spain;(11)Hospital Universitari Germans Trias i Pujol. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology Department, Barcelona, Spain;(12)Hospital Universitario Marqués de Valdecilla, Gastroenterology Department, Santander, Spain;(13)Complexo Hospitalario Universitario de Pontevedra, Gastroenterology Department, Pontevedra, Spain;(14)Hospital Santa Creu i Sant Pau, Gastroenterology Department, Barcelona, Spain;(15)Hospital Universitario Puerta de Hierro, Gastroenterology Department, Madrid, Spain;(16)Hospital Universitario 12 de Octubre, Gastroenterology Department, Madrid, Spain;(17)Hospital Universitario de Canarias, Gastroenterology Department, Tenerife, Spain;(18)Hospital Universitario Ramón y Cajal, Gastroenterology Department, Madrid, Spain;(19)Hospital del Mar, Gastroenterology Department, Barcelona, Spain;(20)Hospital Josep Trueta, Gastroenterology Department, Girona, Spain;(21)Hospital Universitario La Paz, Gastroenterology Department, Madrid, Spain;(22)Hospital Clínico Universitario de Valencia, Gastroenterology Department, Valencia, Spain;(23)Hospital General Universitario Gregorio Marañón, Gastroenterology Department, Madrid, Spain;(24)Hospital Universitario de Álava, Gastroenterology Department, Vitoria, Spain;(25)Complejo Hospitalario Universitario de Navarra, Gastroenterology Department, Navarra, Spain;(26)Hospital Doctor Peset, Gastroenterology Department, Valencia, Spain;(27)Hospital Universitari Parc Taulí, Gastroenterology Department, Sabadell, Spain;(28)Hospital Universitario de La Princesa- Instituto de Investigación Sanitaria Princesa IIS-IP, Gastroenterology Department, Madrid, Spain;(29)Hospital Universitari Mútua Terrasa, Gastroenterology Department, Barcelona, Spain;(30)Hospital Doctor José Molina Orosa, Gastroenterology Department, Lanzarote, Spain;(31)Hospital Universitari Mútua Terrasa. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology Department, Barcelona, Spain;(32)Hospital Universitario de Galdakao and Biocruces Bizkaia Health Research Institute, Gastroenterology Department, Galdakao, Spain; young GETECCU group

Background

Limited data is available of the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). The aim of our study was to describe the natural history of pre-existing IBD and de novo IBD after SOT.

Methods

A retrospective, observational, multi-centre, nationwide study was designed. IBD patients with SOT were included. We identified two separate cohorts: (1) patients with pre-existing IBD at the time of SOT and (2) patients without IBD at the time of SOT (de novo IBD). The primary outcome was IBD progression, defined by the escalation of medical treatment, surgical therapy for medically refractory IBD or IBD-related hospitalization during follow-up. Risk factors were identified using multivariate Cox proportional hazard analysis.

Results

A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) from 31 centres were included. Baseline characteristics are shown in Table 1. Eighty-six patients with IBD and SOT underwent liver transplantation, while 82 required renal, 4 lung, 3 heart, 1 liver/kidney and 1 pancreas/kidney transplantation.

Pre-existing IBD patients were followed-up over a median of 4.8 years (range 2.6-9.4). At the time of SOT, 61 patients (59.8%) were not under maintenance treatment or were treated with 5-aminosalicylates, 10 (9.8%) were on immunosuppressive therapy and 31 (30.4%) were receiving biological agents, of which 8 were on combo therapy. At the moment of SOT, only 8 patients (7.5%) had moderate IBD activity whereas the remaining patients were in remission. During follow-up 33.7% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 years (range 1.3-4.6). No differences between Crohn´s disease and ulcerative colitis were found (Figure 1).

The median time of follow-up in de novo IBD group was 5.1 years (range 2.1-8.2). In this cohort, 55.9% of patients had disease progression during follow-up (Figure 2), with a median time to flare of 1.9 years (range 0.8-3.9) from diagnosis.

In pre-existing IBD cohort, multivariate Cox-regression analysis identified active IBD at the time of SOT (HR=1.80; 95%CI: 1.14-2.84; p=0.012) and the presence of extraintestinal manifestations (HR=3.10; 95%CI: 1.47-6.54; p=0.003) as predictive factors of IBD progression after SOT.






Conclusion

One third of patients with pre-existing IBD have disease progression, needing medical therapy escalation, surgery or hospitalization after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for disease progression. In de novo IBD cohort, about half of patients showed disease progression during follow-up.