CLINICAL COURSE AND MANAGEMENT OF INFLAMMATORY BOWEL-DISEASE AFTER LIVER-TRANSPLANTATION

Background. Previous reports investigating the clinical course and man agement of inflammatory bowel disease (IBD) after orthotopic liver tra nsplant (OLT) have revealed conflicting results, Methods, To determine the natural history and course of therapy for liver transplant patien ts with LED, we reviewed the records of 35 patients, who underwent OLT between 1985 and 1996 and who had a history of either IBD (29 patient s) or primary sclerosing cholangitis (PSC) without evidence of IBD bef ore OLT (6 patients), Of 29 patients with IBD before OLT, 25 had a his tory of ulcerative colitis (UC) and 4 had Crohn's disease, Six patient s had undergone total colectomy, one subtotal colectomy, and three par tial colectomy before OLT, Mean follow-up after OLT was 37+/-6.4 month s, Immunosuppression included cyclosporine, prednisone, and azathiopri ne in 34 patients and tacrolimus and prednisone in 1 patient, Results, After OLT, 17 patients (49%) had quiescent disease and were receiving no additional medications other than standard immunosuppression to pr event organ rejection, Five patients (14%) had mild flares controlled with initiation of 5'-aminosalicylates (5'-ASA), and two patients (6%) required an increase in oral prednisone. Only one patient with PSC, w ithout evidence of IBD before OLT, developed IBD after OLT, No patient s required intravenous steroids or surgical intervention for active IB D, Conclusions, (1) Standard postOLT immunosuppressive agents in patie nts undergoing OLT with IBD were able to adequately control disease ac tivity after OLT in the majority of patients, (2) IBD flares after OLT were generally well controlled with aminosalicylates or oral steroids , (3) Aminosalicylates were helpful in the clinical management of IBD, even when patients were taking standard doses of steroids, azathiopri ne, and cyclosporine.