P738 Real world outcomes on the efficacy and safety of combination of biologic and immunosuppressive therapy in liver transplant recipients with inflammatory bowel disease

Abstract Background Following liver transplantation (LT), more than a third of patients with inflammatory bowel disease (IBD) will have an aggressive disease course, requiring treatment with biologics. Data on efficacy and safety of biologics in this setting are limited. We report our experience in IBD patients on biologics following LT. Methods Data were collected retrospectively from medical files of patients who underwent LT from 1989 to 2019 in a tertiary referral centre and required IBD treatment with biologics post-LT. Clinical and endoscopic responses, and concomitant corticosteroid requirement were used as a measure of efficacy. Adverse events and infections were recorded. Results We identified 10 patients who received treatment with biologics post-LT. The majority were males (n = 7), had a diagnosis of ulcerative colitis (UC) prior to LT (n = 9) and the primary liver disease leading to LT was primary sclerosing cholangitis (PSC). Median time from LT to biologic initiation was 6 years (range 2–17). All patients received tacrolimus as part of anti-rejection therapy, 8 patients were on azathioprine and 2 on mycophenolate mofetil. Two patients had a proctocolectomy prior to LT. The majority (n = 9) were biologic naïve. As a 1st line treatment 7 patients received infliximab (IFX), 1 adalimumab (ADA) and 2 vedolizumab (VDZ). Following allergic reaction to IFX, 2 patients were switched to VDZ. One patient with chronic pouchitis received ADA following IFX failure. Mean duration on IFX in patients on maintenance therapy was 23 months (range 8–33), for ADA 34 months (range 17–50) and for VDZ 12 months (range 6–24). Three patients on IFX (1 with chronic pouchitis) responded to treatment, with one achieving endoscopic remission and another improvement of pouchitis. One patient, despite initial response, treatment escalation and rescue corticosteroids, required colectomy, and so did another after failing both IFX and VDZ. The 2 patients on maintenance ADA showed clinical and endoscopic improvement. Responses to VDZ were mixed; 2 patients improved, but 3 did not respond to VDZ therapy. The infections recorded for patients on IFX (n = 4/7) were cholangitis, Clostridium difficile, TB-related erythema induratum, EBV and CMV colitis, liver and perianal abscesses and Bell’s palsy secondary to CMV/EBV. One patient (n = 1/2) on ADA had a bacterial upper respiratory tract infection, while another on VDZ (n = 1/5) developed pericarditis, corneal ulceration and viral eye infection. No cancers have been detected to date (median follow-up 107 months, range 26–253). Conclusion Anti-TNF and VDZ therapy may be effective in the post-LT IBD setting. Caution is warranted regarding infections, particularly for patients on concomitant anti-rejection therapy and IFX.