PMID- 24707135
OWN - NLM
STAT- MEDLINE
DCOM- 20150413
LR  - 20211021
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 20
IP  - 13
DP  - 2014 Apr 7
TI  - Clinical management of inflammatory bowel disease in the organ recipient.
PG  - 3525-33
LID - 10.3748/wjg.v20.i13.3525 [doi]
AB  - There was estimated a higher incidence of de novo inflammatory bowel disease 
      (IBD) after solid organ transplantation than in the general population. The onset 
      of IBD in the organ transplant recipient population is an important clinical 
      situation which is associated to higher morbidity and difficulty in the medical 
      therapeutic management because of possible interaction between anti-reject 
      therapy and IBD therapy. IBD course after liver transplantation (LT) is variable, 
      but about one third of patients may worsen, needing an increase in medical 
      therapy or a colectomy. Active IBD at the time of LT, discontinuation of 
      5-aminosalicylic acid or azathioprine at the time of LT and use of 
      tacrolimus-based immunosuppression may be associated with an unfavorable outcome 
      of IBD after LT. Anti-tumor necrosis factor alpha (TNFalpha) therapy for refractory 
      IBD may be an effective and safe therapeutic option after LT. The little 
      experience of the use of biological therapy in transplanted patients, with 
      concomitant anti-rejection therapy, suggests there be a higher more careful 
      surveillance regarding the risk of infectious diseases, autoimmune diseases, and 
      neoplasms. An increased risk of colorectal cancer (CRC) is present also after LT 
      in IBD patients with primary sclerosing cholangitis (PSC). An annual program of 
      endoscopic surveillance with serial biopsies for CRC is recommended. A 
      prophylactic colectomy in selected IBD/PSC patients with CRC risk factors could 
      be a good management strategy in the CRC prevention, but it is used infrequently 
      in the majority of LT centers. About 30% of patients develop multiple IBD 
      recurrence and 20% of patients require a colectomy after renal transplantation. 
      Like in the liver transplantation, anti-TNFalpha therapy could be an effective 
      treatment in IBD patients with conventional refractory therapy after renal or 
      heart transplantation. A large number of patients are needed to confirm the 
      preliminary observations. Regarding the higher clinical complexity of this 
      subgroup of IBD patients, a close multidisciplinary approach between an IBD 
      dedicated gastroenterologist and surgeon and an organ transplantation specialist 
      is necessary in order to have the best clinical management of IBD after 
      transplantation.
FAU - Indriolo, Amedeo
AU  - Indriolo A
AD  - Amedeo Indriolo, Paolo Ravelli, Digestive Endoscopy Unit, Department of 
      Gastroenterology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
FAU - Ravelli, Paolo
AU  - Ravelli P
AD  - Amedeo Indriolo, Paolo Ravelli, Digestive Endoscopy Unit, Department of 
      Gastroenterology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 4Q81I59GXC (Mesalamine)
RN  - MRK240IY2L (Azathioprine)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Azathioprine/therapeutic use
MH  - Cholangitis, Sclerosing/complications/therapy
MH  - Colectomy/adverse effects
MH  - Colorectal Neoplasms/complications/therapy
MH  - End Stage Liver Disease/*complications/*therapy
MH  - Graft Rejection/prevention & control
MH  - Heart Transplantation/*adverse effects
MH  - Humans
MH  - Inflammatory Bowel Diseases/complications/*therapy
MH  - Kidney Transplantation/adverse effects
MH  - Liver Transplantation/*adverse effects
MH  - Mesalamine/therapeutic use
MH  - Risk Factors
MH  - Tacrolimus/therapeutic use
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/antagonists & inhibitors
PMC - PMC3974519
OTO - NOTNLM
OT  - Anti-tumor necrosis factor alpha therapy
OT  - Crohn's disease
OT  - Heart transplantation
OT  - Inflammatory bowel disease
OT  - Liver transplantation
OT  - Primary sclerosing cholangitis
OT  - Renal transplantation
OT  - Ulcerative colitis
EDAT- 2014/04/08 06:00
MHDA- 2015/04/14 06:00
PMCR- 2014/04/07
CRDT- 2014/04/08 06:00
PHST- 2013/09/28 00:00 [received]
PHST- 2013/11/06 00:00 [revised]
PHST- 2014/01/19 00:00 [accepted]
PHST- 2014/04/08 06:00 [entrez]
PHST- 2014/04/08 06:00 [pubmed]
PHST- 2015/04/14 06:00 [medline]
PHST- 2014/04/07 00:00 [pmc-release]
AID - 10.3748/wjg.v20.i13.3525 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2014 Apr 7;20(13):3525-33. doi: 10.3748/wjg.v20.i13.3525.