Abstract
Background and Aims
Inflammatory bowel disease (IBD) are not common after kidney transplantation. Development of IBD in the patient on immunosuppression is unexpected, because IBD is believed to be the result of inappropriate and ongoing activation of the mucosal immune system and immunosuppressive drugs are used in the treatment of IBD. The aim of our study was to evaluate the occurrence of de novo IBD, ulcerative colitis and Crohn’s disease, in the patients who received kidney transplant in our hospital, the time after transplantation and the immunosuppression therapy when diagnosis was made.
Method
We used an electronic medical archival system to identify the patients with IBD. Between 1996 and 2018 a total of 462 kidney transplantations were done in Military Medical Academy. Analysis in this study included 400 patients who were regulary controlled in our hospital. Demographic data and clinical findings including age, sex, primary renal disease, type of kidney donor, and immunosuppressive therapy were evaluated. The time of the occurrance of the IBD after transplantation, the colonoscopy and pathologic findings were also noted.
Results
de novo IBD was observed in three patients 19, 11 and 7 years after kidney transplantation respectively. In all patients end-stage renal disease was due to chronic glomerulonephritis without histology verification. Family history was negative in all. They were male, age 40, 42 i 47 years respectively when diagnosis was made. Their immunosuppressive regimen included prednisone, mycophenolate mofetil (MMF) and tacrolimus with a trough level between 5 and 7 ng/ml. They all developed constitutional symptoms with significant weight loss and fever, abdominal pain and cramps, diarrhoea which was in one case bloody. Infectious and other etiology was excluded. Colonoscopy showed ulcerative colitis in two patients and Crohn’s disease in one. The patients with ulcerative colitis responded on maintenance therapy combined with 5-aminosalicylic acid, but one of them had common flare-ups with mild clinical picture. The patient with Crohn’s disease was successfully treated with azathioprine instead of MMF with high-dose steroids.
Conclusion
We concluded that new onset of IBD can develop after kidney transplantation despite use of immunosuppressive therapy. It should be considered in all transplanted patients who develop gastrointestinal complaints. The future studies could answer why the immunosuppressive therapy is not effective for IBD in these group of patients.
De-novo Inflammatory Bowel Disease After Bariatric Surgery: A Large Case Series