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Purpose <p>Approximately 2% of patients with inflammatory bowel disease (IBD) have primary sclerosing cholangitis (PSC), and some require liver transplantation (LT). Managing IBD after LT is challenging given concomitant anti-rejection immunotherapies. We report our experience using upadacitinib (UPA) to treat patients with IBD after LT.</p> Methods <p>Retrospective, single-center observational study at a tertiary center, identifying patients after LT who received UPA. We assessed efficacy and safety of UPA.</p> Results <p>Four patients after LT (Crohn’s disease <i>n</i> = 3; ulcerative colitis <i>n</i> = 1) received UPA for IBD control (<i>n</i> = 3) or as a steroid-sparing adjunct for anti-rejection (<i>n</i> = 1), alongside anti-rejection immunosuppression. Median follow-up from UPA initiation was 10.5&#xa0;months (IQR 8.9–14.6); age 41.5&#xa0;years (IQR 40–44); interval from LT 3.2&#xa0;years (IQR 2.3–5.6). Two receiving prednisone for Crohn’s control at baseline achieved steroid-free remission (Harvey–Bradshaw Index &lt; 5). Three developed liver enzyme elevation: one stopped UPA at one month with subsequent normalization of alanine and aspartate aminotransferase; one underwent liver biopsy showing no rejection and continued UPA with 9-month follow-up; and one receiving UPA for potential anti-organ rejection plus vedolizumab ultimately discontinued UPA for suspected rejection after tapering steroids. One patient experienced mild COVID-19 that resolved without treatment change. No life-threatening adverse events were observed.</p> Conclusion <p>In this small series, UPA controlled IBD activity in 2 of 4 patients after LT but was associated with liver-enzyme elevations in 3, prompting discontinuation in 2. These findings support cautious, closely monitored use and highlight the need for a larger multi-center study of UPA in patients with IBD after LT.</p>

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Safety and Efficacy of Upadacitinib in Patients with Inflammatory Bowel Disease After Liver Transplantation: A Case Series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月20日

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  • Yusuke Miyatani,
  • David Choi,
  • Andrew I. Aronsohn,
  • Anjana Pillai,
  • Russell D. Cohen,
  • David T. Rubin

摘要

Purpose

Approximately 2% of patients with inflammatory bowel disease (IBD) have primary sclerosing cholangitis (PSC), and some require liver transplantation (LT). Managing IBD after LT is challenging given concomitant anti-rejection immunotherapies. We report our experience using upadacitinib (UPA) to treat patients with IBD after LT.

Methods

Retrospective, single-center observational study at a tertiary center, identifying patients after LT who received UPA. We assessed efficacy and safety of UPA.

Results

Four patients after LT (Crohn’s disease n = 3; ulcerative colitis n = 1) received UPA for IBD control (n = 3) or as a steroid-sparing adjunct for anti-rejection (n = 1), alongside anti-rejection immunosuppression. Median follow-up from UPA initiation was 10.5 months (IQR 8.9–14.6); age 41.5 years (IQR 40–44); interval from LT 3.2 years (IQR 2.3–5.6). Two receiving prednisone for Crohn’s control at baseline achieved steroid-free remission (Harvey–Bradshaw Index < 5). Three developed liver enzyme elevation: one stopped UPA at one month with subsequent normalization of alanine and aspartate aminotransferase; one underwent liver biopsy showing no rejection and continued UPA with 9-month follow-up; and one receiving UPA for potential anti-organ rejection plus vedolizumab ultimately discontinued UPA for suspected rejection after tapering steroids. One patient experienced mild COVID-19 that resolved without treatment change. No life-threatening adverse events were observed.

Conclusion

In this small series, UPA controlled IBD activity in 2 of 4 patients after LT but was associated with liver-enzyme elevations in 3, prompting discontinuation in 2. These findings support cautious, closely monitored use and highlight the need for a larger multi-center study of UPA in patients with IBD after LT.