Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Aliment Pharmacol Ther. 2012 Sep;36(6):569-74. doi: 10.1111/j.1365-2036.2012.05217.x. Epub 2012 Jul 10.
Ulcerative colitis (UC) and Crohn's disease can sometimes relapse and be refractory to standard treatment following orthotopic liver transplantation (OLT) despite post-transplantation immunosuppressive therapy.
To evaluate the efficacy and safety of anti-tumour necrosis factor (anti-TNF) agents for the management of IBD following OLT.
We reviewed the records of patients with a diagnosis of IBD who underwent OLT at Mayo Clinic Rochester between 1985 and 2009. Patients were included if they had received anti-TNF therapy post-OLT. Clinical response was defined as a physician's assessment of improvement after 12 weeks of anti-TNF usage, and mucosal healing was defined as the absence of ulcerations on follow-up endoscopy.
The median age of the eight study patients was 42.0 years and 37.5% were female patients. All had been diagnosed with IBD prior to OLT (UC in three and Crohn's disease in five). Indication for OLT was cirrhotic stage primary sclerosing cholangitis (PSC), and three concomitantly had cholangiocarcinoma. Clinical response was demonstrated in seven of eight patients (87.5%) and mucosal healing was demonstrated in three of seven (42.9%). Four infections (oral candidiasis, Clostridium difficile colitis, bacterial pneumonia and cryptosporidiosis) in three patients were reported. One patient developed an Epstein-Barr virus-positive post-transplant lympho-proliferative disorder. One death occurred due to complications from recurrent PSC.
Starting Anti-TNF therapy following orthotopic liver transplantation appears to be a potential option for inflammatory bowel disease management. Additional studies are needed, however, to confirm these findings and to further assess risks associated with this treatment strategy.
溃疡性结肠炎（UC）和克罗恩病在接受原位肝移植（OLT）后，尽管接受了移植后免疫抑制治疗，但有时仍会复发且对标准治疗无效。
评估抗肿瘤坏死因子（anti-TNF）药物在OLT 后治疗 IBD 的疗效和安全性。
我们回顾了 1985 年至 2009 年在梅奥诊所罗切斯特分校接受 OLT 的 IBD 诊断患者的病历。如果患者在 OLT 后接受了抗 TNF 治疗，则将其纳入研究。临床反应定义为医生在使用抗 TNF 药物 12 周后评估的改善，黏膜愈合定义为随访内镜检查无溃疡。
八名研究患者的中位年龄为 42.0 岁，女性占 37.5%。所有患者在 OLT 前均被诊断为 IBD（UC 患者 3 例，克罗恩病患者 5 例）。OLT 的适应证为肝硬化期原发性硬化性胆管炎（PSC），同时有 3 例患者合并胆管癌。八名患者中有七名（87.5%）显示出临床反应，七名中有三名（42.9%）显示出黏膜愈合。三名患者出现了四种感染（口腔念珠菌病、艰难梭菌结肠炎、细菌性肺炎和隐孢子虫病）。一名患者发生了 EBV 阳性移植后淋巴组织增生性疾病。一名患者因复发性 PSC 并发症而死亡。
OLT 后开始使用抗 TNF 治疗似乎是治疗 IBD 的一种潜在选择。然而，需要进一步的研究来证实这些发现，并进一步评估这种治疗策略相关的风险。
