Inflammatory Bowel Disease After Orthotopic Liver Transplantation.

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Am J Gastroenterol. Jun 22, 2006

Five

Cases of De Novo Inflammatory Bowel Disease After Orthotopic Liver Transplantation.

Depart Internal Medicine, Johannes Gutenberg-University Mainz,

Germany.

Immunosuppression is currently the treatment of choice for

severe inflammatory bowel disease (IBD). Thus, it was anticipated that the

course of preexisting IBD should improve after orthotopic

liver transplantation (OLT). Despite sufficient allograft immunosuppressive therapy,

however, exacerbation of IBD or the development of de novo IBD after OLT were

described in some cases, primarily in patients transplanted for end-stage

primary sclerosing cholangitis

(PSC). In addition, the development of de novo IBD in patients undergoing

OLT for indications other than PSC was described. Evaluating our collective of

314 liver transplanted patients we found five patients transplanted for various

indications other than PSC (autoimmune hepatitis [AIH], acute-on-chronic

hepatitis B, 's disease, and cryptogenic cirrhosis) who developed de novo

IBD after OLT despite sufficient immunosuppressive therapy with tacrolimus or cyclosporine. PSC was widely excluded in

these patients by clinical and histological examinations and there was no sign

of an enteric infection. It was remarkable that all patients were suspected to

have an autoimmune background. Four of our patients were women and almost all

patients showed histologically typical signs of an

ulcerative colitis (UC). To prevent allograft rejection, three of five patients

were treated with cyclosporine and the other two with tacrolimus. After diagnosis, treatment with aminosalicylates and corticosteroids led to complete

clinical and histological remission. However, relapses occurred frequently

after termination of specific therapy. In

combination with previous reports, our cases indicate an immune dysregulation leading to the development of de novo IBD

after OLT under immunosuppressive therapy. Reviewing the literature, it should be considered that apart

from the autoimmune background, immunosuppressive therapy may itself play a

major role in the development of de novo IBD. From the clinical point of view, it is of critical importance

to detect this phenomenon, since diarrhea is an important cause of morbidity

and mortality in transplanted patients and therapy for this disorder completely

differs from the treatment for other causes of diarrhea. Aminosalicylates

and courses of corticosteroids offer an effective treatment.

PMID: 16790037 [PubMed - as supplied by publisher]

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