Effectiveness and safety of anti-TNF therapy for inflammatory bowel disease in liver transplant recipients for primary sclerosing cholangitis: A nationwide case series

Publication date: July 2018
Source:Digestive and Liver Disease, Volume 50, Issue 7
Author(s): Romain Altwegg, Roman Combes, David Laharie, Victor De Ledinghen, Sylvie Radenne, Filomena Conti, Olivier Chazouilleres, Christophe Duvoux, Jérôme Dumortier, Vincent Leroy, Xavier Treton, François Durand, Sébastien Dharancy, Maria Nachury, Félix Goutorbe, Géraldine Lamblin, Lucile Boivineau, Laurent Peyrin-Biroulet, Georges-Philippe Pageaux
BackgroundThere is a lack of consensus regarding the treatment of inflammatory bowel disease (IBD) after liver transplantation (LT) forprimary sclerosing cholangitis (PSC).AimTo investigate the safety and effectiveness of anti-TNF therapy in patients with IBD after a LT for PSC.MethodsWe reviewed the medical files of all of the IBD patients who underwent a LT for PSC and who were treated with anti-TNF therapy at 23 French liver transplantation centers between 1989 and 2012.ResultsEighteen patients (12 with ulcerative colitis and 6 who had Crohn’s disease) were recruited at 9 LT centers. All of these patients received infliximab or adalimumab following their LT, and the median duration of their anti-TNF treatment was 10.4 months. The most frequent concomitant immunosuppressive treatment comprised a combination of tacrolimus and corticosteroids. Following anti-TNF therapy induction, a clinical response was seen in 16/18 patients (89%) and clinical remission in 10 (56%). At the end of the anti-TNF treatment or at the last follow-up examination (the median follow-up was 20.9 months), a clinical response was achieved in 12 patients (67%) and clinical remission in 7 (39%). A significant endoscopic improvement was observed in 9 out of 14 patients and a complete mucosal healing in 3 out of 14 patients (21%). Six patients experienced a severe infection. These were due to cholangitis, cytomegalovirus (CMV) infection, Clostridium difficile, cryptosporidiosis, or Enterococcus faecalis. Three patients developed colorectal cancer after LT, and two patients died during the follow-up period.ConclusionsAnti-TNF therapy proved to be effective for treating IBD after LT for PSC. However, as 17% of the patients developed colorectal cancer during the follow-up, colonoscopic annual surveillance is recommended after LT, as specified in the current guidelines.