Department of Medical Sciences, Division of Gastroenterology, University of Turin, Turin, Italy.
Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium.
J Crohns Colitis. 2023 Jul 5;17(7):1097-1102. doi: 10.1093/ecco-jcc/jjad030.
Solid organ transplantation, with the exception of liver, has rarely been reported in patients affected by inflammatory bowel diseases [IBD].
This is an ECCO-CONFER project collecting cases of solid organ transplants [with the exclusion of liver] that were performed in IBD patients. We evaluated the change in the IBD therapy, need for bowel resection due to medically refractory IBD, or need for hospitalisation due to IBD relapse ['severe IBD course'] before and after transplantation.
in total, 34 organ transplantations [28 kidney, five heart, one lung] in 33 IBD patients were collected [67% male, 55% Crohn's disease, mean age 53 ± 16 years]. The median follow-up was 4.3 years (interquartile range [IQR] 3.2-10.7); 29 patients [87.9%] were treated with tacrolimus, 25 [76%] with systemic steroids, 22 [67%] with mycophenolate mofetil, 11 [33%] with everolimus, six with cyclosporine [18%]. One patient was treated with infliximab, two patients with adalimumab, two patients with vedolizumab, one patient with ustekinumab. Overall, a severe IBD course was observed in three [9.3%] patients before transplantation and in four [11.7%] in the post-transplant setting [p = 0.26]. Three cases of cancer [excluding skin non-melanoma] [9.1%] were recorded in the post-transplantation period versus two in the pre-transplantation period [6.1%, p = 0.04]. Six patients [18.2%] died during the period of observation. No deaths were associated with IBD or complications of the transplant.
In IBD patients, solid organ transplantation does not seem to impact on the IBD severity. However, the risk of malignancy needs further investigation.
除肝脏外，炎症性肠病（IBD）患者的实体器官移植极为少见。
这是一项 ECCO-CONFER 项目，收集 IBD 患者接受的实体器官移植（不包括肝脏）病例。我们评估了移植前后 IBD 治疗的变化、因医学难治性 IBD 而需要肠切除术或因 IBD 复发[“严重 IBD 病程”]而需要住院治疗的情况。
共收集 33 例 IBD 患者 34 例器官移植（28 例肾、5 例心、1 例肺）[67%为男性，55%为克罗恩病，平均年龄 53±16 岁]。中位随访时间为 4.3 年（四分位间距[IQR] 3.2-10.7）；29 例（87.9%）患者接受他克莫司治疗，25 例（76%）接受全身皮质类固醇治疗，22 例（67%）接受霉酚酸酯治疗，11 例（33%）接受依维莫司治疗，6 例（18%）接受环孢素治疗。1 例患者接受英夫利昔单抗治疗，2 例患者接受阿达木单抗治疗，2 例患者接受维得利珠单抗治疗，1 例患者接受乌司奴单抗治疗。总体而言，3 例（9.3%）患者在移植前和 4 例（11.7%）患者在移植后存在严重 IBD 病程[P=0.26]。在移植后观察期间记录了 3 例[排除皮肤非黑色素瘤]癌症[9.1%]病例，而移植前为 2 例[6.1%]病例[P=0.04]。6 例（18.2%）患者在观察期间死亡。没有与 IBD 或移植并发症相关的死亡。
在 IBD 患者中，实体器官移植似乎不会影响 IBD 的严重程度。然而，恶性肿瘤的风险需要进一步研究。
