Natural history of inflammatory bowel disease patients submitted to solid organ transplantation.

Studies on the natural history of patients with inflammatory bowel disease (IBD) submitted to solid organ transplantation (SOT) reported contradictory results. Most studies report a more aggressive course of the intestinal disease after transplantation.1,2 There are factors which have been associated with the development of IBD “de novo” after transplantation, such as CMV infection (i.e., patients with negative CMV serology receiving organs from CMV positive donors appear to have increased risk for developing IBD).3,4 Other factors have proven, in published series, to be risk factors for worsening of pre-existing IBD, they are: symptoms of IBD at the time of transplantation, liver transplantation for primary sclerosing cholangitis (PSC) and immunosuppression with tacrolimus.2,4,5 The use of azathioprine after transplantation appears to be a protective factor for both, worsening of pre-existing IBD, and IBD onset.2 We performed a retrospective analysis of IBD patients attending our clinics with two objectives: to evaluate the characteristics of patients with IBD that had undergone SOT and to analyze the impact of SOT on the natural history and therapy of IBD. Patients were divided into two groups: IBD diagnosed before SOT and IBD diagnosed after SOT. Eleven patients were included in the analysis: