Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Mar 26, 2024; 16(3): 257-266
Published online Mar 26, 2024. doi: 10.4252/wjsc.v16.i3.257
Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn’s disease
Min Young Park, Yong Sik Yoon, Jae Ha Park, Jong Lyul Lee, Chang Sik Yu
Min Young Park, Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
Yong Sik Yoon, Jae Ha Park, Jong Lyul Lee, Chang Sik Yu, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Park MY designed and performed the research and wrote the paper; Yoon YS designed the research and supervised the report; Park JH contributed to the analysis; Lee JL and Yu CS provided clinical advice and supervised the report.
Supported by the grants from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea, No. 2019IF0593 and No. 2020IP0039.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Asan Medical Center (No. 2020-1059).
Informed consent statement: This is a retrospective study that used anonymous data, and the Institutional Review Board of Asan Medical Center approved the study and waived informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Sik Yoon, MD, PhD, Professor, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. yoonys@amc.seoul.kr
Received: October 13, 2023
Peer-review started: October 13, 2023
First decision: December 11, 2023
Revised: December 25, 2023
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 26, 2024
Processing time: 163 Days and 21.3 Hours
Abstract
BACKGROUND

Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease (CD). Anti-tumor necrotic factor (TNF) therapy combined with drainage procedure is effective as well. However, previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula closure.

AIM

This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula (CPF) closure rates after stem cell transplantation with and without anti-TNF therapy, and to identify the factors affecting CPF closure and recurrence.

METHODS

The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were enrolled. Clinical data were compared according to anti-TNF therapy and CPF closure.

RESULTS

A total of 65 patients were included. The median age of females was 26 years (range: 21-31) and that of males was 29 (44.6%). The mean follow-up duration was 65.88 ± 32.65 months, and complete closure was observed in 50 (76.9%) patients. The closure rates were similar after stem cell transplantation with and without anti-TNF therapy (66.7% vs 81.6% at 3 year, P = 0.098). The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture (P = 0.027, 0.002, and 0.008, respectively). Clinical factors such as complexity, number of fistulas, presence of concurrent abscess, and medication were not significant for closure. The cumulative 1-, 2-, and 3-year closure rates were 66.2%, 73.8%, and 75.4%, respectively.

CONCLUSION

Anti-TNF therapy does not increase CPF closure rates in patients with stem cell transplantation. However, both refractory and non-refractory CPF have similar closure rates after additional anti-TNF therapy. Fistulous tract length, proctitis, and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.

Keywords: Crohn’s disease; Anus; Fistula; Stem cell transplantation; Tumor necrosis factor-alpha inhibitors; Infliximab

Core Tip: This study examined the closure rates of Crohn’s perianal fistula (CPF) in patients undergoing stem cell transplantation for treatment. The complete closure was observed in 76.9% of cases, with similar closure rates after stem cell transplantation with and without anti-tumor necrotic factor (TNF) therapy. Factors associated with higher closure rates included shorter fistulous tracts and the absence of proctitis and anorectal stricture. Clinical factors such as complexity, number of fistulas, concurrent abscess presence, and medication did not significantly affect closure. The cumulative 1-, 2-, and 3-year closure rates were 66.2%, 73.8%, and 75.4%, respectively, suggesting that anti-TNF therapy did not increase CPF closure rates.