A case series of transplant recipients who despite immunosuppression developed inflammatory bowel disease

Thomas R. Riley, Robert E. Schoen, Randall G. Lee, Jorge Rakela

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Abstract

Objectives: We describe 14 patients who developed inflammatory bowel disease (IBD) after transplantation despite immunosuppression. Methods: Using an electronic medical archival retrieval system, records of 6800 liver and kidney transplant patients were searched for evidence of IBD. The pathology was reviewed, and infectious etiologies were excluded. Results: Fourteen patients developed IBD after transplantation. Twelve patients had undergone liver transplantation, and two kidney transplantation. Four had transplantation for autoimmune hepatitis; four for non-A, non-B, non-C hepatitis; two for primary sclerosing cholangitis; one for giant cell hepatitis; one for biliary artresia; one for polycystic kidney disease; and one for obstructive uropathy. Mean age at development of IBD was 38 yr. Mean time to development of IBD after transplantation was 4 yr. Endoscopically there were two cases limited to the left side, eight of pancolitis, of which one had terminal ileal disease, and four of patchy colitis. Histology was consistent with ulcerative colitis in nine patients and Crohn's disease in five. Patients with ulcerative colitis either responded and remained in remission on maintenance therapy (seven of nine) or were refractory and required a colectomy (two of nine). Patients with Crohn's disease continued to have flares despite treatment (five of five). Conclusion: 1) New onset IBD can develop after solid organ transplantation, despite use of immunosuppressive therapy. 2) A fall spectrum of IBD can be seen after transplantation. 3) Study of these patients could shed light on why immunosuppression is not uniformly effective for IBD and provide clues to the inflammatory determinants of IBD.

Original languageEnglish (US)
Pages (from-to)279-282
Number of pages4
JournalAmerican Journal of Gastroenterology
Volume92
Issue number2
StatePublished - Feb 1997
Externally publishedYes

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Inflammatory Bowel Diseases
Immunosuppression
Transplantation
Ulcerative Colitis
Crohn Disease
Hepatitis
Ileal Diseases
Medical Electronics
Transplant Recipients
Polycystic Kidney Diseases
Autoimmune Hepatitis
Sclerosing Cholangitis
Colectomy
Organ Transplantation
Giant Cells
Colitis
Immunosuppressive Agents
Liver Transplantation
Kidney Transplantation
Histology

ASJC Scopus subject areas

  • Gastroenterology

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A case series of transplant recipients who despite immunosuppression developed inflammatory bowel disease. / Riley, Thomas R.; Schoen, Robert E.; Lee, Randall G.; Rakela, Jorge.

In: American Journal of Gastroenterology, Vol. 92, No. 2, 02.1997, p. 279-282.

Research output: Contribution to journalArticle

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