Non-hepatic Solid Organ Transplant in Patients with Inflammatory Bowel Disease: An ECCO CONFER Multicentre Case Series

Abstract

Background and Aims Solid organ transplantation, with the exception of liver, has rarely been reported in patients affected by inflammatory bowel diseases (IBD). Methods This is an ECCO-CONFER project collecting cases of solid organ transplants (with the exclusion of liver) that were performed in IBD patients. We evaluated the change in the IBD therapy, need for bowel resection due to medically refractory IBD, or need for hospitalization due to IBD relapse (“severe IBD course”) before and after transplantation. Results Thirty-four organ transplantations (28 kidney, five heart, one lung) in 33 IBD patients were collected (67% male; 55% Crohn’s disease, mean age 53 ± 16 years). The median follow-up was 4.3 years (IQR 3.2 – 10.7). Twenty-nine patients (87.9%) were treated with tacrolimus, 25 (76%) with systemic steroids, 22 (67%) with mycophenolate mofetil, 11 (33%) with everolimus, six with cyclosporine (18%). One patient was treated with infliximab, two patients with adalimumab, two patients with vedolizumab, one patient with ustekinumab. Overall, a severe IBD course was observed in three (9.3%) patients before transplantation and in four (11.7%) in the post-transplant setting (p = 0.26). Three cases of cancer (excluding skin non-melanoma) (9.1%) were recorded in post-transplantation period versus two in the pre-transplant (6.1%, p = 0.04). Six patients (18.2%) died during the period of observation. No deaths were associated with IBD or complications of the transplant. Conclusions In IBD patients, solid organ transplantation does not seem to impact on the IBD severity. However, the risk of malignancy needs further investigation.

Safety of Biologics and Small Molecules for Inflammatory Bowel Diseases in Organ Transplant Recipients

“…Recent meta-analyses do not suggest a clear association with safety outcomes, including malignancy and death after transplantation, in patients with IBD. 24 25 Among 15 patients with IBD who received biologics or small molecules after transplantation in this study, one died due to graft failure during the study period, whereas one case of post-transplant lymphoproliferative disorder and one case of drug-related organizing pneumonia were identified. No colorectal cancer or IBD-related deaths were identified.…”