Do Kidney Transplant Medications Supplant IBD Drugs?

ORLANDO -- Many patients who undergo successful renal transplantation and also have Crohn's disease were able to avoid immunomodulating or biologic agents to control their gut disease, researchers found.

Of 37 patients with renal transplants who were also diagnosed with inflammatory bowel disease, 48.6% were off medical therapy for treatment of Crohn's disease after transplant, reported Marianny Sulbaran, MD, PhD, a fellow in gastroenterology at the Mayo Clinic in Jacksonville, Florida.

"Because patients who have undergone renal transplants required anti-rejection drugs which reduce immune response to the transplanted organ, we think that these drugs may also reduce the activity in Crohn's disease," Sulbaran told MedPage Today in discussing her poster presentation here at the Advances in Inflammatory Bowel Diseases conference.

The relatively few patients who have both Crohn's disease and have had renal transplant has made studies of these patients difficult, and Sulbaran's aim was to fill in some of the holes in the data on these patients.

In commenting on the study, Svein-Oskar Frigstad, MD, PhD, chief of gastroenterologist at Vestre Viken Bærum Hospital/University of Oslo, Norway, agreed. "Although 37 patients may not seem like many, this is quite a large study for this group of patients."

But it's an area that needs to be addressed, Frigstad told MedPage Today. "Renal transplantation is performed quite frequently, so it is always a possibility that there will be individuals who also have inflammatory bowel disease such as Crohn's disease.

In reviewing records at Mayo between 2016 and 2022, the researchers identified 37 individuals with transplants and Crohn's disease for their study. The patients' mean age was 58.8 years, and 62% of the group were men. In 33 of the subjects (89% of the cohort), the diagnosis of Crohn's disease preceded the kidney transplant. The mean duration of Crohn's disease diagnosis was 24.4 years; the average age at diagnosis of Crohn's disease was 32.4 years, with a range from as young as 9 years to as old as 69 years, Sulbaran reported.

In her study group, most of the patients were taking triple combination therapy to prevent rejection of the transplant which included tacrolimus, mycophenolic acid and predisone. About a third of the patients were on two of those agents, Sulbaran said.

When Sulbaran and colleagues scrutinized patient outcomes, they found that 20 of the patients or 54% were in clinical remission from their Crohn's disease; 65% of the patients were both in clinical remission from Crohn's disease and off medical treatment for Crohn's disease after renal transplant. Fourteen of the patients did have active Crohn's disease following transplant; 16 patients were prescribed biologic agents to combat Crohn's disease after transplant.

Of those patients who were on biologic agents to control Crohn's disease, Sulbaran reported that seven were taking infliximab, six were on vedolizumab (Entyvio), and three were on ustekinumab (Stelara).

"When needed, addition of biologic therapy for treatment of Crohn's disease to patients on post-renal immunosuppression should be considered in collaboration with the transplant team," she said.

Frigstad noted that tacrolimus, a mainstay of treatment to prevent organ rejection, has been used in the past to control Crohn's disease symptoms. "What is impressive about this study, is that about half the patients did not require further immunomodulating or biologic drugs for their inflammatory bowel disease as long they were on chronic renal transplant immunosuppressive therapy," Frigstad said.

He also concurred that adding biologics or other agents for the treatment of active Crohn's disease needed to involve discussions with the transplant team.

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