S0851 Safety and Efficacy of Anti-TNF-α and Anti-Integrin Biologics in the Treatment of Inflammatory Bowel Disease After Liver Transplantation

Abstract

INTRODUCTION: After liver transplantation, patients with corticosteroid or immunomodulator–refractory Inflammatory Bowel Disease (IBD) may need to be managed with biologic therapies. This poses a major clinical challenge as there is an increased risk of infectious events in transplant patients. There is a paucity of evidence regarding the use of biologic agents in liver transplant recipients. In a patient population at higher risk for malignancy and infection, this study evaluates the safety and efficacy of anti-TNFα an anti-integrin biologics in patients with IBD after liver transplantation. METHODS: We performed a comprehensive literature search using PubMed and SCOPUS to identify papers, letters and abstracts regarding liver transplant recipients on biologic therapeutics. This was supplemented by a manual screening of references within studies and review articles. Two reviewers (SK and ML) extracted data independently. The outcomes from individual case reports and cases series were subsequently pooled into anti-TNFα an anti-integrin cohorts. RESULTS: We identified 26 case reports and case series that met our inclusion criteria. Of patients who developed de novo or recurrent IBD after liver transplantation, 75 were found to be on anti-TNFα therapy and 42 on an anti-integrin therapy. Clinical response or remission of IBD activity in liver transplant recipients was reported in 57 (76%) of patients on anti-TNFα therapy and 30 (71.4%) of patients on vedolizumab. Mucosal healing was observed at a lower incidence in both therapeutic groups (44.4% in anti-TNFα pool, 69.2% in the anti-integrin pool). Adverse complications included infection (CMV infection, Clostridium difficile (C.dif) colitis, and recurrent cholangitis). Clostridium infections were observed In 21.4% of the Vedolizumab pool compared to 10.3% of the anti-TNFα pool. CONCLUSION: There currently are no randomized controlled studies or retrospective comparative studies evaluating the use of biologics in IBD patients after liver transplant. Based on the literature, the use of anti-TNF and anti-integrin therapy seems to be safe and effective after liver transplantation. The reported clinical response to anti-TNF and anti-integrin therapies appears higher in the transplant population compared to the rates of near 40% in the general IBD population without liver transplant, which may reflect the effect of baseline immunosupression of patients post-transplant. However, comparing remission rates is challenging between these two populations.Table 1.: Efficacy and Safety Outcomes of Biologics in patients with IBD after liver transplant