Single-Center Investigation on the Prevalence, Risk Factors, and Outcomes of Non-infective Inflammatory Bowel Disease...

Inflammatory bowel diseases (IBDs) are progressive, immune-mediated conditions including Crohn Disease and ulcerative colitis. Heart transplant (HTx) represents the most successful treatment for patients with end-stage heart failure. Lifelong immunosuppressive therapy to prevent graft rejection is associated with a decreased incidence and prevalence of immune-mediated diseases; however, de novo non-infective IBDs have been reported in transplant recipients. This study aims to describe clinical characteristics and variables that may influence the onset of non-infective IBD following HTx.

We performed a single-center, retrospective, observational study at Monaldi Hospital, Naples. Hospitalized patients that received a diagnosis of non-infective IBD after HTx were included.

A total of 10 males were included, median age at IBD onset was 56 years [45-64.5]. The median time interval between HTx and IBD diagnosis was 8.5 years [3-12.7]. IBD onset was characterized by rectal bleeding (70%), abdominal pain (70%), chronic diarrhea (60%), and weight loss (20%). A total of 60% of the subjects experienced cytomegalovirus reactivation after transplant, and IBD ensued a median of 3 years [2-12] after reactivation. The most common histological diagnosis was indeterminate colitis. All patients on cyclosporine and most treated with tacrolimus and everolimus had higher than recommended mean plasma trough levels of immunosuppressive drugs during the year before IBD diagnosis. All patients received mesalazine, with a 40% increase in the prednisone dose. One patient underwent surgery for complications, and one died 3 years after IBD diagnosis as a result of intestinal perforation.

De novo IBD is a possible complication after HTx and should be promptly suspected when gastrointestinal symptoms persist. Cytomegalovirus reactivation and high exposure to immunosuppressants are possible risk conditions.