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Oral budesonide for the therapy of post-liver transplant de novo inflammatory bowel disease: A case series and systematic review of the literature

Barritt, Sidney A. IV MD1,*; Zacks, Steven L. MD, MPH1; Rubinas, Tara C. MD2; Herfarth, Hans H. MD1

doi: 10.1002/ibd.20528
Original Clinical Articles

Background: The therapy for posttransplant IBD is clinically challenging. Patients receiving liver transplants are immunosuppressed to prevent rejection, but via an unknown mechanism develop de novo IBD in spite of receiving some of the same medications used for therapy in traditional IBD. In the published literature most of the patients who developed de novo IBD were treated with traditional corticosteroids. Exposure to systemic corticosteroids increases risks of infection, diabetes mellitus, and osteoporosis among other complications. Budesonide, a luminally active steroid with low systemic absorption, is an established therapeutic agent for IBD that should receive special considerations as first-line therapy in this patient population.

Methods: We describe 3 cases of de novo IBD after liver transplantation. None of these patients had a history of IBD prior to their transplant. All 3 were treated with oral budesonide in lieu of systemic corticosteroids. Additionally, a Medline MeSH search was performed using the terms “inflammatory bowel disease” and “liver transplant” as part of a systematic review of the literature.

Results: All 3 cases of de novo post transplant IBD went into clinical remission with oral budesonide. The Medline search ultimately revealed 19 case reports, case series or retrospective reviews on de novo post liver transplant IBD. Most reports focused on the diagnosis and risk factors and did not have an emphasis on therapy.

Conclusions: Given the track record for budesonide in traditional IBD, and its documented efficacy and systemic steroid-sparing benefit, in our opinion this drug should be considered first-line therapy for de novo posttransplant IBD.

1Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina

2Department of Pathology, University of North Carolina, Chapel Hill, North Carolina

* Division of Gastroenterology and Hepatology, University of North Carolina, Campus Box 7080, Chapel Hill, NC 27599-7080 (e-mail:

Received 6 May 2008; Accepted 9 May 2008

Published online 10 July 2008 in Wiley InterScience (

© Crohn's & Colitis Foundation of America, Inc.
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