Renal Transplant Improves Outcomes in Half of Patients With Crohn Disease

Undergoing a renal transplant may lead to clinical remission in patients with Crohn disease.

Crohn disease (CD) diagnosis frequently occurred before renal transplantation, an intervention which led to clinical remission in more than half and to cessation of additional biologic therapies in almost half of patients with CD, according to study results presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2022 conference, held from December 5 to 7, 2022, in Orlando, Florida.

Researchers conducted a retrospective study between January 2016 and August 2022 to assess the outcomes of 37 patients with CD with at least 6 months of follow-up following renal transplantation (men, 62%; mean age, 58.8[range, 27-84] years; mean disease duration, 24.4[range, 1-70] years).

Diagnosis of CD preceded renal transplantation in 89.2% of patients. Most patients had ileal or ileocolonic involvement (73%), while most of the remaining patients had colonic involvement (18.9%). One patient had perianal disease with ileocolonic involvement (2.7%), and the location of the CD was not available for the last 3 patients (8.1%).

Following renal transplantation, 54.1% of patients achieved clinical remission of CD while on chronic immunosuppression therapy to prevent rejection of the transplant. The remaining patients either had active CD (14 patients; 37.8%) or no data was available (3 patients; 8.1%).

When needed, addition of biologic therapy to patients’ post-renal immunosuppression should be considered in collaboration with the transplant team.

The most common posttransplant medications used in 67.6% of the cohort included tacrolimus, mycophenolic acid, and prednisone.

Researchers discovered that 65% of patients who achieved clinical remission of CD did not require additional biologic treatment other than the immunosuppressives they were currently taking. While some patients required biologic therapies for CD, including infliximab (7), vedolizumab (6), and ustekinumab (3), 48.6% of patients did not require pharmacological treatments for their CD after renal transplantation.

“The diagnosis of Crohn’s disease frequently preceded renal transplant,” the study authors wrote. “In this cohort, almost half of patients on chronic renal transplant immunosuppressive therapy did not require additional biologic agents for management of their Crohn’s disease. When needed, addition of biologic therapy to patients’ post-renal immunosuppression should be considered in collaboration with the transplant team.”

References:

Sulbaran M, Kinnucan J, Picco M, Farraye F, Hashash J. Outcomes of Crohn’s disease in patients after renal transplant. Abstract presented at: AIBD 2022; December 5-7, 2022; Orlando, FL. Abstract 80.