S1482 Impact of Advanced Therapy on Safety and Outcomes in Patients With Inflammatory Bowel Disease and Primary Sclerosing Cholangitis After Liver Transplantation

Introduction: Primary sclerosing cholangitis (PSC) accounts for approximately 5% of liver transplants (LTs) annually in the United States, and most PSC patients have concurrent inflammatory bowel disease (IBD-PSC). Managing IBD-PSC after LT is challenging due to the need to balance immunosuppression and IBD therapy. This study evaluates the safety and outcomes of advanced IBD therapies (AT) in IBD-PSC patients following LT. Methods: We identified IBD-PSC patients from the TriNetX database who underwent LT and were maintained on anti-rejection therapy (ART), with or without additional AT. Outcomes were assessed over 5 years, comparing patients with and without AT, before and after propensity score matching (PSM). Primary outcomes included incidence of serious and opportunistic infections, IBD-related surgeries, and cancer. Secondary outcomes included liver-related complications and all-cause mortality. Results: Among 549,944 IBD patients, 765 had IBD-PSC and underwent LT. Of these, 178 received AT post-LT and 587 received ART alone. The most common ATs were vedolizumab (45%), ustekinumab (30%), and anti-tumor necrosis factor-alpha agents (26%). Prior to matching patients receiving AT had higher rates of intestinal infections (21.90% vs 13.30%, P = 0.005) and Clostridiodes difficile enterocolitis (12.90% vs 7.70%, P = 0.03). After PSM, serious and opportunistic infections were similar between groups. However, intestinal infections (20.80% vs 11.40%, P = 0.02) and other viral infections (21.50% vs 12.10%, P = 0.03) remained more common in the AT group. No significant differences were found in IBD surgeries, cancer, graft rejection and failure, or all-cause mortality. Conclusion: Advanced IBD therapies are generally safe in IBD-PSC patients post-LT, with vedolizumab and ustekinumab being the most commonly used agents.