INFLAMMATORY BOWEL DISEASE AND LIVER TRANSPLANTATION: A PROPENSITY-MATCHED STUDY OF POST-TRANSPLANT COMPLICATIONS AND SURVIVAL

Abstract Background/Aims Inflammatory bowel disease (IBD) is frequently associated with liver transplantation (LT), most often due to primary sclerosing cholangitis (PSC). However, post-transplant outcomes in patients with IBD compared to non-IBD recipients remain poorly defined. We aimed to evaluate short- and intermediate-term complications and survival after LT in recipients with underlying IBD. METHODS Using the TriNetX research network, we identified adult patients with IBD (Crohn’s disease or ulcerative colitis) who underwent LT. Propensity score matching (1:1) was performed with LT recipients without IBD to adjust for baseline confounders. Outcomes of interest included hospitalization, acute rejection, graft failure, infection, and all-cause mortality. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. RESULTS We identified 4,070 LT recipients with IBD and matched them to 4,070 non-IBD LT controls. Compared with controls, the IBD group had higher risks of hospitalization (62.6% vs. 58.1%; HR 1.07), acute rejection (23.4% vs. 16.1%; HR 1.48; p < 0.001), and graft failure (17.6% vs. 11.2%; HR 1.59; p < 0.001). All-cause mortality was slightly higher in the IBD group (15.8% vs. 14.4%; HR 1.05; p = 0.068), though this did not reach statistical significance. Infection risk also trended higher (14.0% vs. 12.1%; HR 1.12; p = 0.13). CONCLUSION In this large, propensity-matched analysis, LT recipients with IBD experienced significantly higher rates of acute rejection, graft failure, and hospital utilization compared with non-IBD recipients, despite similar survival. These findings highlight the need for tailored post-transplant monitoring and risk stratification in this high-risk population.