Inflammatory bowel disease–like conditions after organ transplantation

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Introduction

The reported prevalence of diarrhea is up to 72% after solid-organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT) . Some of them have acute and/or chronic endoscopic and histologic of the gastrointestinal (GI) tract, with some having features of inflammatory bowel disease (IBD). Immunological factors exert a key role in the process of OT. Similar factors are important in the etiopathogenesis of IBD. The association between OT and IBD is complex. The patient undergoes OT may have existing IBD, especially in those with primary sclerosing cholangitis (PSC). Solid-organ transplant (SOT) or HSCT may develop de novo IBD or IBD-like conditions. The classic example is cord colitis syndrome . The use of antirejection medicines can cause IBD or IBD-like conditions, with a typical example of mycophenolate mofetil (MMF)–associated colitis . Antirejection medications with their immunosuppressive effect may lead to bacterial (such as Clostridium difficile ) , viral [such as cytomegalovirus (CMV)] , fungal, or parasitic infections, neutropenia, and immune deficiency, mimicking IBD. Besides, graft-versus-host disease (GVHD) of the GI tract can develop after HSCT or SOT with endoscopic and histologic features resembling that in IBD.

Patients with de novo IBD and IBD-like conditions commonly present with diarrhea after SOT or HSCT. The frequency of de novo IBD appears to be more common in orthotopic liver transplantation (OLT) than that of other solid organ transplantations. De novo IBD or IBD-like conditions can develop despite the use of antirejection immunosuppressive medications . It is speculated that damage-associated molecular patterns (DAMP) and pathogen-associated molecular patterns and their associated ongoing inflammation in the transplanted organ, as well as the recipients’ small and large bowel, are possible etiologies.

The characterization of posttransplantation de novo IBD or IBD-like conditions is important for the diagnosis, management, and prognosis of the affected GI organs as well as the maintenance of healthy transplanted organs.