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

Table 1

Five patients with inflammatory bowel disease, primary sclerosing cholangitis, and liver transplant treated with antitumor necrosis factor alpha agents.

	IBD type	Age at IBD onset	Age at PSC onset	Age at LT	Pre-LT TNFα agent	Liver donor status	Post-LT TNFα agent	Concomitant immunosuppression	Complications	IBD disease activity
Patient 1: white male	Crohn’s	9	11	17	None	Deceased	Adalimumab	Cyclosporine; mycophenolate mofetil	C. diff colitis, esophageal candidiasis, CMV viremia, PTLD, Death	Hospital admission; prednisone escalation; colectomy
Patient 2: white female	UC	18	20	25	None	Living unrelated	Infliximab	Tacrolimus; azathioprine	Pancytopenia	Hospital admission; prednisone escalation; active colitis
Patient 3: white male	UC	29	32	41	None	Deceased	Infliximab	Tacrolimus	MRSA bacteremia; pneumonia with sepsis; C. diff. colitis.	Hospital admission; prednisone escalation; active colitis
Patient 4: white female	UC	26	33	48	None	Deceased	Infliximab	Tacrolimus; mycophenolate mofetil	Acute rejection; C. diff colitis	Hospital admission; colectomy
Patient 5: white male	Crohn’s	29	33	45	Adalimumab	Deceased	Adalimumab	Tacrolimus	PTLD	Active colitis

IBD: inflammatory bowel disease; PSC: primary sclerosing cholangitis; LT: liver transplant; TNFα: tumor necrosis factor alpha; C. diff: Clostridium difficile; CMV: cytomegalovirus; PTLD: posttransplant lymphoproliferative disease; UC: ulcerative colitis.