S4853 Treatment Resistant Inflammatory Bowel Disease (IBD) in Patients With Prior Organ Transplantation: A Case Series

Introduction: Inflammatory bowel disease (IBD) is challenging to manage in patients who have undergone solid organ transplantation. Immunosuppressive therapy can lead to treatment resistance or even trigger de novo IBD. The complex interplay between transplant immunosuppression and IBD pathophysiology often results in difficult-to-control disease and higher morbidity. This case series presents 5 cases of treatment-resistant IBD following organ transplantation, aiming to shed light on the clinical presentations and management obstacles. Case Description/Methods: Five patients (ages 30–62) with histories of kidney, liver, or heart transplantation were diagnosed with either persistent or de novo IBD. Despite ongoing immunosuppression, these patients exhibited severe, treatment-resistant symptoms. A 38-year-old male liver transplant recipient with ulcerative colitis (UC) experienced worsening symptoms post-transplant. Anti- tumor necrosis factor therapy provided partial symptom improvement but recurrent flares. A 45-year-old woman kidney transplant recipient developed Crohn’s-like symptoms that did not respond to corticosteroids or mesalamine. Limited control was achieved with biologics. A 62-year-old man with primary sclerosing cholangitis and prior liver transplantation developed de novo UC with aggressive progression, requiring frequent hospitalizations and combined immunosuppressive therapy. A 30-year-old male heart transplant recipient developed severe UC within 2 years post-transplant. Immunosuppressive therapy was intensified, yet symptoms persisted, indicating resistance. A 50-year-old woman post-kidney transplant experienced refractory colitis misdiagnosed initially as drug-related colitis. Eventually, Crohn’s was diagnosed and anti-integrin therapy was introduced. Discussion: These cases highlight the complexity of managing IBD in organ transplant recipients. Immunosuppressive therapies required for organ graft survival and IBD treatments can exacerbate disease progression, leading to treatment resistance. Evidence suggests that biologic therapies, while beneficial for some, may not fully address the treatment resistance observed in post-transplant IBD. Treatment-resistant IBD in transplant recipients poses challenges, necessitating novel therapeutic strategies or intensified monitoring. Further research is warranted to optimize treatment protocols and identify risk factors contributing to IBD flares in this population ultimately improving post-transplant quality of life.