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Z Gastroenterol 2018; 56(02): 117-127
DOI: 10.1055/s-0043-117183
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Immunosuppression following liver transplantation and the course of inflammatory bowel disease – a case control study

Immunsuppression nach Lebertransplantation und der Verlauf chronisch entzündlicher Darmerkrankungen – eine Fall-Kontroll-Studie
Martina T. Mogl
1   Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Germany
,
Daniel C. Baumgart
2   Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
,
Andreas Fischer
2   Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Charité Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
,
Johann Pratschke
1   Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Germany
,
Andreas Pascher
1   Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Germany
› Author Affiliations
Further Information

Publication History

18 April 2017

17 July 2017

Publication Date:
06 December 2017 (online)

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Abstract

Aim The aim of this study was to investigate the influence of immunosuppression following orthotopic liver transplantation (OLT) on course of inflammatory bowel disease (IBD) including disease activity and complications.

Methods Out of 1168 patients undergoing liver transplantation between 1988 and 2000 at our center, we identified those with IBD (n = 67). In a comparative cohort study, IBD patients after OLT were compared to controls without OLT. All drugs including immunosuppressive and anti-inflammatory medication and complications during follow-up were recorded in 6-month intervals. Also, surgical interventions before and after OLT as well as endoscopic interventions with macroscopic and microscopic findings were collected and analyzed. Additionally, development of malignant neoplasias was recorded.

Results Of the 67 individuals with IBD and OLT, 41 were available for analyses and compared with 42 controls. The mean follow-up was 7.4 (range: 3 – 15) years. Short-term therapy with calcineurin inhibitors or mycophenolate mofetil led to short-term remission, yet sustained remission could only be achieved in patients receiving mycophenolate mofetil. At 14.5 years, clinical remission was reached by significantly more patients in the transplant group (54 %) than in the control group (33 %, p = 0.0295). Patients in the control group required nearly 2 times as many surgical interventions related to IBD than patients in the transplant group. Neoplasias were more common in the OLT (n = 8) compared with 4 solid organ cancers in the control group, respectively.

Conclusions Our data demonstrate an overall positive impact of immunosuppression following OLT on the course of IBD, especially with mycophenolate mofetil, but an increased rate of malignancies.

Zusammenfassung

Einleitung Die vorliegende Studie untersucht den Einfluss der Immunsuppression nach Lebertransplantation auf den Verlauf chronisch entzündlicher Darmerkrankungen insbesondere hinsichtlich entzündlicher Aktivität und Komplikationen.

Methoden Von 1168 Patienten, die zwischen 1988 und 2000 in unserem Zentrum lebertransplantiert wurden, hatten 67 eine chronisch entzündliche Darmerkrankung (CED). In einer Fall-Kontroll-Analyse wurden diese Patienten mit CED-Patienten ohne Lebertransplantation (LTx) verglichen. Im Beobachtungszeitrum wurden alle Immunsuppressiva und anti-inflammatorischen Medikamente sowie Komplikationen in 6-Monats-Intervallen erfasst. Auch chirurgische und endoskopische Eingriffe mit mikro- und makroskopischen Befunden wurden erfasst und analysiert, ebenso wie das Auftreten von Malignomen.

Ergebnisse Von den 67 Patienten mit CED und LTx konnten 41 analysiert und mit 42 Kontroll-Patienten verglichen werden. Der Beobachtungszeitrum lag im Mittel bei 7.4 Jahren (3 – 15 Jahre). Eine anhaltende Remission konnte nur bei Patienten mit MycophenolatMofetil erzielt werden. Nach 14.5 Jahren hatten signifikant mehr Patienten aus der Transplant-Gruppe (54 %) eine klinische Remission ihrer CED (p = 0.0295). Patienten der Kontrollgruppe mussten sich nahezu doppelt so vielen chirurgischen Eingriffen unterziehen, wie die Patienten der Transplant-Gruppe. Malignome entwickelten sich öfter in der Transplant-Gruppe (n = 8), als in der Kontrollgruppe (n = 4), allerdings nicht signifikant.

Diskussion Unsere Daten zeigen einen günstigen Einfluss der Immunsuppression nach Lebertransplantation auf den Verlauf der CED, insbesondere mit MycophenolatMofetil als Kombinationstherapie.

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - Immunsuppression - Lebertransplantation

Key words

Crohn’s disease - ulcerative colitis - immunosuppression - liver transplantation
 

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