S1784 Outcomes and Management of Inflammatory Bowel Disease Patients With Primary Sclerosing Cholangitis After Liver Transplantation: A Single-Center Case Series

Introduction: Primary sclerosing cholangitis (PSC) is associated with inflammatory bowel disease (IBD) in up to 70% of cases. However, data regarding IBD management and outcomes in PSC patients following liver transplantation (LT) remains limited. This study aims to characterize IBD-directed therapies utilized post-LT and clinical outcomes in PSC-IBD patients post-LT. Methods: We identified patients with PSC who underwent liver transplantation at Virginia Commonwealth University Medical Center from 2019-2024. Demographic, clinical, and treatment data were collected for patients with concurrent IBD. Clinical outcomes of interest included IBD activity, treatment modifications, infectious complications, and hospitalizations following LT. Results: Fifteen patients with PSC/IBD were included. PSC was the primary indication for LT for all patients, however 26.7% also had autoimmune hepatitis overlap. Living donors were used for 40% of transplants. Prior to transplantation, 93.3% had a known IBD diagnosis (92.9% ulcerative colitis, 7.1% Crohn’s disease) with a median IBD duration of 6 years (IQR 3.5-8.5). There were 42.9% of patients requiring surgical intervention for IBD prior to LT, most commonly proctocolectomy. Aminosalicylates (35.7%) were the most used IBD-specific therapy at time of transplantation. One patient developed de novo Crohn’s disease 4 years post-LT. The median number of follow-up years post-transplant was 2.8 years (IQR 2.3-4.7). After transplantation, 33.3% of patients required initiation of advanced IBD therapy. Among those requiring therapy escalation post-LT, vedolizumab (80%) was frequently utilized followed by risankizumab (20%) and adalimumab (20%). The most common infectious complications post-LT included cytomegalovirus (20%) and C. difficile (13.3%) infection. Overall, 53.3% of patients experienced at least one hospitalization post-LT related to an IBD flare, including pouchitis. Infection-related hospitalizations due to viremia, bacteremia, infectious colitis, and intraabdominal abscess, occurred in 26.7% of patients. Conclusion: This study demonstrates PSC/IBD patients often will require hospitalization for IBD-related symptoms even after transplantation. Frequent causes of hospitalizations in these patients include infections in the setting of transplant immunosuppression therapy as well as advanced IBD therapies. Further studies are necessary to identify the specific risk factors for these infectious complications and hospitalizations in the post-transplant population.