There have been conflicting reports on the prevalence and severity of inflammatory bowel disease after liver transplantation.
In this study, researchers from the Netherlands retrospectively evaluated the prevalence of inflammatory bowel disease after liver transplantation. They also assessed the possible relationship of inflammatory bowel disease with maintenance immunosuppressive regimens.
The team assessed 48 patients with end-stage primary sclerosing cholangitis and 30 patients with autoimmune cirrhosis, who were transplanted between 1979 and 2001. All patients had at least 1 year of follow-up available.
The researchers collected data on patient and transplant characteristics, inflammatory bowel disease, and immunosuppression before and after transplantation.
They used Kaplan-Meier analysis to assess survival.
|Pre-transplant inflammatory bowel disease, and the use of tacrolimus, were independent predictors for inflammatory bowel disease after transplantation.|
|Alimentary Pharmacology and Therapeutics|
In addition, risk factors for inflammatory bowel disease after transplantation were evaluated using Cox univariate and multivariate regression.
The researchers found that the median follow-up after transplantation was 7.2 years.
The team determined that 9 of 25 patients with pre-transplant inflammatory bowel disease had flare-ups after transplantation.
Of the 53 patients in the study without pre-transplant inflammatory bowel disease, 6 developed de novo inflammatory bowel disease after transplantation.
The researchers found that the cumulative risk of inflammatory bowel disease 1 year after transplantation was 6%. After 3 years this risk was 12%, and after 5 years it was 20%.
They found that inflammatory bowel disease-free survival was higher in patients not receiving tacrolimus, compared with those who were receiving tacrolimus. Disease-free survival was also higher in patients receiving azathioprine, compared with those who were not, and in patients taking the prednisolone-azathioprine-ciclosporin A, compared with those taking tacrolimus-prednisolone.
The research team identified pre-transplant inflammatory bowel disease and the use of tacrolimus as independent predictors for inflammatory bowel disease after transplantation.
Dr Haagsma's team concluded, "The prevalence of inflammatory bowel disease after liver transplantation is affected by the immunosuppression used".
"Azathioprine seems to have a protective effect and tacrolimus a promoting effect".