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Case Reports in Gastrointestinal Medicine
Volume 2018, Article ID 1015408, 5 pages
https://doi.org/10.1155/2018/1015408
Case Report

Tumor Necrosis Factor Alpha Inhibition for Inflammatory Bowel Disease after Liver Transplant for Primary Sclerosing Cholangitis

1Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI, USA
2Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

Correspondence should be addressed to Nirmal Kaur; gro.shfh@1ruakn

Received 8 January 2018; Accepted 15 April 2018; Published 15 May 2018

Academic Editor: Warwick S. Selby

Copyright © 2018 Ravish Parekh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Outcome data regarding the use of tumor necrosis factor alpha inhibitors (anti-TNFα) in patients with inflammatory bowel disease (IBD) after liver transplant (LT) for primary sclerosing cholangitis (PSC) are scant. Methods. We performed a retrospective chart review to investigate outcomes among a series of post-liver-transplant PSC/IBD patients receiving anti-TNFα therapy at Henry Ford Health System ((HFHS), Detroit, MI). Results. A total of five patients were treated with anti-TNFα agents for IBD after LT for PSC from 1993 through 2015. Two patients were treated with adalimumab, and three were treated with infliximab. Three patients were hospitalized with severe posttransplant infections. Two patients developed posttransplant lymphoproliferative disease (PTLD); one of these patients died due to complications of PTLD. Conclusion. Anti-TNFα treatment following LT worsened the disease course in our patients with concurrent PSC/IBD and led to serious complications and surgical intervention. Larger studies are needed to evaluate the side effects and outcomes of the use of such agents in this patient population. Until then, clinicians should have a high threshold to use anti-TNFα therapy in this setting.