Case Report: Severe Colonic Crohn Disease Initiated after Liver Transplantation Requiring Surgery^[*]

Abstract

Introduction A patient using tacrolimus for hepatocyte transplantation (HT) was diagnosed with Crohn disease (CD) with mainly colonic involvement, despite drug immunosuppression due to the previous transplant. Upon routine colonoscopy, a lateral growth lesion was detected, which was endoscopically unresectable. Therefore, it was decided to perform a total colectomy with burial of the rectum and terminal ileostomy. During surgery, thickening of the terminal ileum and cecum was visualized, along with “fat-wrapping” and thickening of the entire mesocolon.

Discussion Immunosuppression in patients with HT should control the activity of autoimmune diseases. However, the literature shows evidence of some reports of inflammatory bowel disease (IBD) activity after liver transplantation (LT). A review article from 2015 highlighted 92 cases of IBD after LT in the literature, with only 14 being CD, demonstrating that this is a rare phenomenon. Among the hypotheses, cytomegalovirus infection is related to the increased disease activity in patients with IBD and HT. In addition, several studies show an association between the drugs used in immunosuppression after LT and relapsed IBD, important data in patients receiving tacrolimus.

Conclusion The occurrence of CD after LT is rare and seems to have a direct association with the immunosuppression used to prevent rejection of the transplanted organ.

Keywords

inflammatory bowel disease - Crohn Disease - liver transplantation - total colectomy - treatment surgical

Authors' Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection and analysis were carried out by Gabriela Feres Sapienza, Rodrigo Ambar Pinto, Ítalo Beltrão Simões and Maria Clara Traldi. The first version of the manuscript was written by Gabriela Feres Sapienza, Rodrigo Ambar Pinto and Ítalo Beltrão Simões, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. The anatomopathological material and images were performed by Felipe Lourenço Ledesma and Camilla Marchiolli. The material of the tomography images were performed by Manuel Rocha.

^* Manuscript produced at Hospital das Clinicas, (HCFMUSP). Universidade de São Paulo, Faculty of Medicine, Departament of gastroenterology, Coloproctology Unit- São Paulo (SP), Brazil.

Publication History

Received: 10 February 2024

Accepted: 05 June 2024

Article published online:
21 August 2024

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