Anti-TNF Therapy for Inflammatory Bowel Disease following Solid Organ Transplantation: A Case Series

Abstract

Purpose: Inflammatory bowel disease (IBD) can occur de novo or flare following solid organ transplantation (SOT) despite significant immunosuppression. The advent of biologic therapy (i.e., anti-TNF agents) for IBD has provided promising options for patients with refractory, steroid dependent and fistulizing disease. However, these agents are associated with adverse events such as infections and malignancies which can pose a dilemma in post-transplant patients already on other immunosuppressive agents. It is established that combining various immunosuppressive medications can put patients at increased risk for infections and post-transplant lymphop-roliferative disorders. While anti-TNF agents have been used with increasing frequency in IBD, there is limited literature addressing the outcomes of transplant patients on immunosuppression for SOT who are simultaneously treated with anti-TNF agents for IBD. The purpose of this study is to assess the outcomes of patients with a history of SOT who are simultaneously treated for IBD with an anti-TNF agent. Methods: We conducted a retrospective chart review of three post-transplant patients from our IBD center who had been placed on an anti-TNF agent for control of IBD. Factors looked at in our chart review included type of transplant, indication for transplant, episodes of rejection, flare of known IBD v. de novo occurrence, concomitant medications, infectious complications, type of anti-TNF agent and time for response to anti-TNF agent. Results: The cases included two liver transplants (one for fulminant hepatic failure of unknown etiology, one for PSC) and a renal transplant (for PCKD). One patient had known IBD prior to transplantation. Two were diagnosed post-transplant. Two patients were treated with infliximab, one with adalimumab. All responded well to anti-TNF therapy. Only one episode of infection was encountered following initiation of anti-TNF agent. This was an episode of pyelonephritis in the renal transplant patient which occurred in the setting of a rectovaginal fistula. No further episodes occurred after surgical repair of fistula. No episodes of rejection occurred in any of these patients while they were on an anti-TNF agent.Table: Characteristics of patients reviewedConclusion: Anti-TNF therapy appears to be effective in post-transplant patients with IBD. Among certain well-monitored post-transplant patients with IBD who have failed standard therapy, anti-TNF therapy may be a viable option. Disclosure: Dr Mahadevan is a consultant for UCB, Centocor and Abbott.