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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2017; 23(18): 3214-3227
Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3214
Inflammatory bowel disease in liver transplanted patients
Tajana Filipec Kanizaj, Maja Mijic
Tajana Filipec Kanizaj, Department of Gastroenterology, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Maja Mijic, University Hospital Merkur, Zagreb 10000, Croatia
Author contributions: Filipec Kanizaj T developed the design and was the primary writer of this paper; Mijic M made the literature review, contributed to writing, design and revision.
Conflict-of-interest statement: All authors who have taken part in this study declared that they have nothing to disclose regarding funding or conflict of interest with respect to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tajana Filipec Kanizaj, Assistant Professor, PhD, Department of Gastroenterology, University Hospital Merkur, School of Medicine, University of Zagreb, Zajceva 19, Zagreb 10000, Croatia. tajana.filipec@gmail.com
Telephone: +38-598-623903 Fax: +38-512-431393
Received: January 28, 2017
Peer-review started: February 7, 2017
First decision: March 3, 2017
Revised: April 13, 2017
Accepted: April 21, 2017
Article in press: April 21, 2017
Published online: May 14, 2017
Processing time: 106 Days and 14.6 Hours
Abstract

Most common hepatobiliary manifestation of inflammatory bowel disease (IBD) are primary sclerosing cholangitis (PSC) and autoimmune hepatitis, ranking them as the main cause of liver transplantation (LT) in IBD setting. Course of pre-existing IBD after LT differs depending on many transplant related factors. Potential risk factors related to IBD deterioration after LT are tacrolimus-based immunosuppressive regimens, active IBD and cessation of 5-aminosalicylates at the time of LT. About 30% patients experience improvement of IBD after LT, while approximately the same percentage of patients worsens. Occurrence of de novo IBD may develop in 14%-30% of patients with PSC. Recommended IBD therapy after LT is equivalent to recommendations to overall IBD patients. Anti-tumor necrosis factor alpha appears to be efficient for refractory IBD. Due to potential side effects it needs to be applied with caution. In average 9% of patients require proctocolectomy due to medically refractory IBD or colorectal carcinoma. The most frequent complication in patients who undergo proctocolectomy with ileal-pouch anal anastomosis is pouchitis. It is still undeterminable if LT adds to risk of developing pouchitis in PSC patients. Annual colonoscopies are recommended as surveillance and precaution of colonic malignancies.

Keywords: Inflammatory bowel disease; Anti-TNF alpha therapy; Liver transplantation; Immunomodulatory therapy; Immunosuppression; Proctoproctocolectomy; Risk factors

Core tip: Management of inflammatory bowel disease in setting of liver transplantation (LT) is a clinical challenge because of intermittent flares and remissions of the disease, regardless of post-LT immunosuppression to prevent organ rejection. In this article we report new insight on actual knowledge ondiagnostic and treatment opportunities in pre- and post-transplant period.