Inflamm Bowel Dis. 2024 Mar 22:izae041. doi: 10.1093/ibd/izae041. Online ahead of print.

Iria Bastón-Rey ¹, Iago Rodríguez-Lago ², Ana María Luque ³, Berta Caballol ^4 5, Carlos Soutullo-Castiñeiras ⁶, Ana Bravo ⁷, Andrés Castaño ⁸, Beatriz Gros ⁹, Lorena Bernal ¹⁰, María Teresa Diz-Lois ¹¹, Horacio Alonso-Galán ¹², Fiorella Cañete ^5 13, Beatriz Castro ¹⁴, Pablo Pérez-Galindo ¹⁵, Carlos González-Muñoza ¹⁶, Ismael El Hajra ¹⁷, Pilar Martínez-Montiel ¹⁸, Inmaculada Alonso-Abreu ¹⁹, Francisco Mesonero ²⁰, María González-Vivo ²¹, Laia Peries ²², Eduardo Martín-Arranz ²³, Carlos Abril ²⁴, Ignacio Marín-Jiménez ²⁵, Ruth Baltar ²⁶, Miren Vicuña ²⁷, Nadia Moreno ²⁸, Eduard Brunet ^5 29, Cristina Rubín de Célix ^5 30, Ingrid Fajardo ³¹, Noelia Cruz ³², Cristina Calvino-Suárez ¹, María Rojas-Feria ³, Agnes Fernández-Clotet ^4 5, Marta Gimeno-Torres ⁶, Laura Nieto-Garcia ¹, Daniel de la Iglesia ¹, Yamile Zabana ^5 31, Cristina Suárez-Ferrer ²³, Manuel Barreiro de Acosta ¹

Author information

¹Gastroenterology Department, Complexo Hospitalario Universitario de Santiago de Compostela and Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain.

²Gastroenterology Department, Hospital Universitario de Galdakao and Biocruces Bizkaia Health Research Institute, Galdakao, Spain.

³Gastroenterology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain.

⁴Gastroenterology Department, Hospital Clínic i Provincial, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.

⁵Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.

⁶Gastroenterology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

⁷Gastroenterology Department, Hospital Regional Universitario de Málaga, Málaga, Spain.

⁸Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.

⁹Gastroenterology Department, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, Spain.

¹⁰Gastroenterology Department, Hospital General de Alicante and Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, Alicante, Spain.

¹¹Gastroenterology Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.

¹²Gastroenterology Department, Hospital Universitario Donostia and Biodonostia Health Research Institute, San Sebastián- Gipuzkoa, Spain.

¹³Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.

¹⁴Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

¹⁵Gastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.

¹⁶Gastroenterology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain.

¹⁷Gastroenterology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.

¹⁸Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.

¹⁹Gastroenterology Department, Hospital Universitario de Canarias, Tenerife, Spain.

²⁰Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.

²¹Gastroenterology Department, Hospital del Mar, Barcelona, Spain.

²²Gastroenterology Department, Hospital Josep Trueta, Girona, Spain.

²³Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain.

²⁴Gastroenterology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.

²⁵Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

²⁶Gastroenterology Department, Hospital Universitario de Álava, Vitoria, Spain.

²⁷Gastroenterology Department, Hospital Universitario de Navarra, Navarra, Spain.

²⁸Gastroenterology Department, Hospital Doctor Peset, Valencia, Spain.

²⁹Gastroenterology Department, Hospital Universitari Parc Taulí, Sabadell, Spain.

³⁰Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa and Universidad Autónoma de Madrid, Madrid, Spain.

³¹Gastroenterology Department, Hospital Universitari Mútua Terrasa, Barcelona, Spain.

³²Gastroenterology Department, Lanzarote, Spain.

Abstract

Background: Limited data are available on the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). We describe the natural history of pre-existing IBD and de novo IBD after SOT.

Methods: This was a retrospective, multicenter study that included patients with pre-existing IBD at the time of SOT and patients with de novo IBD after SOT. The primary outcome was IBD progression, defined by escalation of medical treatment, surgical therapy, or hospitalization due to refractory IBD. Risk factors were identified using multivariate Cox proportional hazard analysis.

Results: A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) were included. Most patients with pre-existing IBD (92.5%) were in remission before SOT. During follow-up, 32% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 (interquartile range, 1.3-4.6) years. In the de novo cohort, 55% of patients had disease progression with a median time to flare of 1.9 (interquartile range, 0.8-3.9) years after diagnosis. In the pre-existing IBD cohort, active IBD at the time of SOT (hazard ratio, 1.80; 95% confidence interval, 1.14-2.84; P = .012) and the presence of extraintestinal manifestations (hazard ratio, 3.10; 95% confidence interval, 1.47-6.54; P = .003) were predictive factors for IBD progression.

Conclusions: One-third of patients with pre-existing IBD and about half of patients with de novo IBD have disease progression after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for IBD progression.