Solid Organ Transplantation Does Not Worsen IBD Severity

Nonhepatic solid organ transplantations do not significantly increase severity of IBD course in patients with inflammatory bowel disease (IBD); however, risk of solid tumor development increases following transplantation, according to study findings published in the Journal of Crohn’s & Colitis.

Researchers conducted a retrospective, observational, multicenter study analyzing the outcomes of 34 nonhepatic solid organ transplantations in 33 patients with IBD with a median follow-up of 4.3 years. Of the 33 patients with IBD, 67% were men, 55% had Crohn disease, and average age at transplantation was 53 years.

The 24 organ transplantations included 28 kidneys, 5 hearts, and 1 lung.

Researchers assessed whether solid organ transplantation resulted in alterations in IBD therapy, bowel resections due to refractory IBD, or hospitalization due to IBD relapse following transplantation.

After solid organ transplantation, immunosuppressive treatments included tacrolimus (87.9% of patients), systemic steroids (75.8%), mycophenolate mofetil (66.7%), everolimus (33.3%), cyclosporine (18.2%), thiopurines (9.1%), and sirolimus (3%). Post-transplantation biologic therapies for IBD included infliximab (3%), adalimumab (6.1%), vedolizumab (6.1%), and ustekinumab (3%).

During the follow-up period, organ rejection occurred in 7 of the 33 patients (21.2%): 3 severe kidney rejections, 2 mild kidney rejections, and 1 each of mild lung and heart rejections. Six of the 33 patients (18.2%) died during follow-up due to causes unrelated to transplantation or IBD complications.

In the 4.3 years prior to transplantation, 9.3% of the patients experienced a severe course of IBD, whereas 11.7% of patients experienced severe courses of IBD following transplantation (P =.26). Following transplantation, 6 patients (18.2%) required hospitalization secondary to IBD relapse and 2 (6.1%) required bowel resections due to worsening IBD. However, these treatments for relapsed or worsening IBD did not differ significantly from pre-transplantation percentages (hospitalization, P =.11; resection, P =.32).

Prior to transplantation, 28 infections occurred, whereas 29 severe infections occurred after transplantation (P =.90). Two cases of cancer occurred before transplantation whereas 10 occurred following transplantation (hazard ratio [HR], 10.0; 95% CI, 0.8-118.9; P =.04). This finding indicated that solid organ transplantation may increase the risk for developing solid tumors.

“We showed that solid organ transplantation is not associated with a worsening of IBD course, although a major incidence of solid tumors may occur,” the study authors wrote. “We observed a medium-term survival rate of about 80%, which would enhance careful screening strategies. Future studies are needed to explore the risk of cancer in IBD populations undergoing solid organ transplantation.”

Study limitations include restriction to national cohorts, the retrospective design, the reliance on voluntary case submissions by physicians making the study subject to geographical and selection biases, and small sample sizes.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.