| Inflammatory bowel disease after liver transplantation: the effect of different immunosuppressive regimens. | |
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MedLine Citation:
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PMID: 12848624 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Seemingly conflicting results have been reported on the prevalence and severity of inflammatory bowel disease after liver transplantation. Regimens with different combinations of drugs can be used for immunosuppression after transplantation. AIM: To study retrospectively the prevalence of inflammatory bowel disease after liver transplantation, and the possible relationship with maintenance immunosuppressive regimens. METHODS: All 78 patients with end-stage primary sclerosing cholangitis (48 patients) or autoimmune cirrhosis (30 patients), transplanted between 1979 and July 2001, and with a follow-up of at least 1 year, were eligible for this study. In addition to patient and transplant characteristics, data on inflammatory bowel disease and immunosuppression before and after transplantation were collected. The Kaplan-Meier method was used for survival analysis. Possible risk factors for inflammatory bowel disease after transplantation were analysed by Cox univariate and multivariate regression. RESULTS: The median follow-up after transplantation was 7.2 years (range, 1.1-22.3 years). Nine of 25 patients with pre-transplant inflammatory bowel disease experienced flare-ups after transplantation. Six of 53 patients without pre-transplant inflammatory bowel disease developed de novo inflammatory bowel disease after transplantation. The cumulative risks (standard errors in parentheses) for inflammatory bowel disease were 6% (3%), 12% (4%) and 20% (5%) at 1, 3 and 5 years after transplantation, respectively. The inflammatory bowel disease-free survival was significantly higher in patients not receiving tacrolimus vs. those receiving tacrolimus, in patients receiving azathioprine vs. those not receiving azathioprine and in patients taking the regimen prednisolone-azathioprine-ciclosporin A vs. those taking tacrolimus-prednisolone. Pre-transplant inflammatory bowel disease and the use of tacrolimus were found to be independent predictors for inflammatory bowel disease after transplantation. CONCLUSIONS: The prevalence of inflammatory bowel disease after liver transplantation is affected by the immunosuppression used. Azathioprine seems to have a protective effect and tacrolimus a promoting effect. |
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Authors:
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E B Haagsma; A P Van Den Berg; J H Kleibeuker; M J H Slooff; G Dijkstra |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Alimentary pharmacology & therapeutics Volume: 18 ISSN: 0269-2813 ISO Abbreviation: Aliment. Pharmacol. Ther. Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-09 Completed Date: 2003-10-09 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8707234 Medline TA: Aliment Pharmacol Ther Country: England |
Other Details:
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Languages: eng Pagination: 33-44 Citation Subset: IM |
Affiliation:
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Department of Gastroenterology and Hepatology, University Hospital Groningen, The Netherlands. e.b.haagsma@int.azg.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Azathioprine / therapeutic use Cyclosporine / therapeutic use Drug Therapy, Combination Female Follow-Up Studies Humans Immunosuppressive Agents / adverse effects* Inflammatory Bowel Diseases* / chemically induced, prevention & control Liver Transplantation* Male Middle Aged Postoperative Complications / etiology*, prevention & control Prospective Studies Risk Factors Tacrolimus / adverse effects |
| Chemical | |
Reg. No./Substance:
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0/Immunosuppressive Agents; 109581-93-3/Tacrolimus; 446-86-6/Azathioprine; 59865-13-3/Cyclosporine |
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