A CASE SERIES OF TRANSPLANT RECIPIENTS WHO DESPITE IMMUNOSUPPRESSION DEVELOPED INFLAMMATORY BOWEL-DISEASE

Objectives: We describe 14 patients who developed inflammatory bowel d isease (IBD) after transplantation despite immunosuppression. Methods: Using an electronic medical archival retrieval system, records of 680 0 liver and kidney transplant patients were searched for evidence of I BD. The pathology was reviewed, and infectious etiologies were exclude d. Results: Fourteen patients developed IBD after transplantation. Twe lve patients had undergone liver transplantation, and two kidney trans plantation. Four had transplantation for autoimmune hepatitis; four fo r non-A, non-B, non-C hepatitis; two for primary sclerosing cholangiti s; one for giant cell hepatitis; one for biliary artresia; one for pol ycystic kidney disease; and one for obstructive uropathy. Mean age at development of IBD was 38 yr. Mean time to development of IBD after tr ansplantation was 4 yr. Endoscopically there were two cases limited to the left side, eight of pancolitis, of which one had terminal peal di sease, and four of patchy colitis. Histology was consistent with ulcer ative colitis in nine patients and Crohn's disease in five. Patients w ith ulcerative colitis either responded and remained in remission on m aintenance therapy (seven of nine) or were refractory and required a c olectomy (two of nine). Patients with Crohn's disease continued to hav e flares despite treatment (five of five). Conclusion: 1) New onset IB D can develop after solid organ transplantation, despite use of immuno suppressive therapy. 2) A full spectrum of IBD can be seen after trans plantation. 3) Study of these patients could shed light on why immunos uppression is not uniformly effective for IBD and provide clues to the inflammatory determinants of IBD.