Rate, Risk Factors, and Outcomes of de novo Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis ACG Governors Award for Excellence in Clinical Research

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Introduction: The risk factors and clinical course of de novo inflammatory bowel disease (IBD) after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is poorly understood. Our aim is to determine the rate, risk factors and outcomes of de novo IBD in patients (pts) with PSC undergoing LT. Methods: We identified all pts with PSC who underwent LT at Mayo Clinic, Rochester from 1984-2012, with follow-up through February 5, 2015. Information on development and course of de novo IBD, in a subset of PSC pts without IBD at time of LT, was extracted. Univariate survival analysis was performed to identify demographic, transplant and immunosuppression-related risk factors associated with development of de novo IBD; due to limited number of events, a multivariate Cox proportional hazard analysis could not be performed. Results: Three hundred seventy-three pts with PSC underwent LT, of whom 77.7% had associated IBD. Eighty-four pts without IBD at time of LT formed the study cohort (mean age, 49±12 yrs, 56% males). Over a median follow-up (interquartile range) of 11.7 yrs (5.5-17.1) after LT, 22 pts (26.2%) developed de novo IBD (20 pts with ulcerative colitis, 1 pt with Crohn's disease, and 1 pt with indeterminate colitis). Cumulative incidence of de novo IBD at 1, 5 and 10 years after LT was 5.5%, 20.0% and 25.4%, respectively. The majority of pts had a mild course requiring either no therapy (18.2%) or only 5-aminosalicylates (68.2%); only 3 patients required IBD-directed immunosuppression. Four pts underwent colectomy after LT for colorectal neoplasia. Mycophenolate mofetil (MMF) post-LT was associated with an increased risk (HR, 3.3; 95% CI, 1.3-9.5), whereas azathioprine use was associated with decreased risk of de novo IBD (HR, 0.2; 95% CI, 0.1-0.6). CMV infection, recurrence of PSC in allograft or use of tacrolimus were not associated with development of de novo IBD after LT (Table). Conclusion: The 10-year risk of de novo IBD after LT for PSC was 25.4%. Transplant-related immunosuppression may modify risk of de novo IBD, with increased risk with MMF post-LT, and decreased risk with azathioprine.Table 1: Factors associated with development of de novo IBD after LT for PSC