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Long-Term Clinical and Endoscopic Outcomes of Crohn’s Disease Following Liver Transplantation: A Multicenter Cohort Study

ORCID
0009-0008-5018-2187
Affiliation
Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany;(E.A.);(C.V.);(K.W.);(J.R.-A.);(H.H.S.)
Ar, Ebru;
ORCID
0009-0003-7768-069X
Affiliation
Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, 48149 Muenster, Germany;(I.S.);(R.V.);(P.-R.T.);(J.T.)
Solomonidou, Irini;
ORCID
0000-0002-0903-1415
Affiliation
Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, 30625 Hannover, Germany;(H.L.);(M.W.)
Lenzen, Henrike;
ORCID
0000-0002-7644-1529
Affiliation
Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, 30625 Hannover, Germany;(H.L.);(M.W.)
Wiestler, Miriam;
ORCID
0009-0005-3471-5957
Affiliation
Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany;(E.A.);(C.V.);(K.W.);(J.R.-A.);(H.H.S.)
Veltkamp, Claudia;
ORCID
0000-0002-1474-7733
Affiliation
Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany;(E.A.);(C.V.);(K.W.);(J.R.-A.);(H.H.S.)
Willuweit, Katharina;
ORCID
0000-0001-8216-0064
Affiliation
Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany;(E.A.);(C.V.);(K.W.);(J.R.-A.);(H.H.S.)
Rashidi-Alavijeh, Jassin;
ORCID
0000-0002-2402-7764
Affiliation
Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany;(E.A.);(C.V.);(K.W.);(J.R.-A.);(H.H.S.)
Schmidt, Hartmut H.;
ORCID
0000-0003-3208-7924
Affiliation
Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, 48149 Muenster, Germany;(I.S.);(R.V.);(P.-R.T.);(J.T.)
Vollenberg, Richard;
ORCID
0000-0002-2757-4755
Affiliation
Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, 48149 Muenster, Germany;(I.S.);(R.V.);(P.-R.T.);(J.T.)
Tepasse, Phil-Robin;
ORCID
0000-0002-7028-3881
Affiliation
Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, 48149 Muenster, Germany;(I.S.);(R.V.);(P.-R.T.);(J.T.)
Trebicka, Jonel;
ORCID
0009-0008-8876-9354
Affiliation
Medical Clinic III, Gastroenterology, Metabolic Diseases, and Intensive Care, University Hospital RWTH Aachen, 52074 Aachen, Germany;(S.T.);(C.E.);(K.H.)
Tischendorf, Stefanie;
ORCID
0009-0002-2869-1272
Affiliation
Medical Clinic III, Gastroenterology, Metabolic Diseases, and Intensive Care, University Hospital RWTH Aachen, 52074 Aachen, Germany;(S.T.);(C.E.);(K.H.)
Elfers, Carsten;
ORCID
0000-0002-1702-2746
Affiliation
Medical Clinic III, Gastroenterology, Metabolic Diseases, and Intensive Care, University Hospital RWTH Aachen, 52074 Aachen, Germany;(S.T.);(C.E.);(K.H.)
Hamesch, Karim;
ORCID
0000-0002-4238-751X
Affiliation
Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany;(E.A.);(C.V.);(K.W.);(J.R.-A.);(H.H.S.)
Bokemeyer, Arne

Patients with Crohn’s disease (CD) may require liver transplantation (LT) due to advanced liver diseases, including primary sclerosing cholangitis (PSC), autoimmune hepatitis, or other etiologies. However, data on CD activity and the use of advanced therapies following LT are limited. This study aimed to assess CD activity before and after LT and to evaluate the use of advanced therapies in this setting. Methods: In this multicenter retrospective cohort study, we analyzed 40 patients with CD who underwent LT between 2000 and 2022 at four university hospitals in Germany. Clinical and endoscopic disease activity, as well as the use of advanced therapies, were evaluated before and after transplantation. Results: Before LT, 89.7% of patients were in clinical remission, which remained stable after LT (85.7%; p = 0.650). Nevertheless, 22.6% of these patients demonstrated moderate to severe mucosal inflammation on endoscopy during long-term follow-up. The use of advanced therapies remained low after transplantation (pre-LT: 11.7%, post-LT: 7.5%; p = 0.532) even among those with endoscopic disease activity. Conclusions: Although clinical remission of CD is usually maintained following LT, endoscopic evidence of persistent mucosal inflammation is common and may be underrecognized. Despite this, advanced therapies are not frequently used in the post-transplant setting. These findings suggest that individualized treatment strategies are needed to address subclinical disease activity while balancing therapeutic effectiveness with transplant-specific risks.

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Editor:
Laudisi, Federica
Published in:
Biomedicines  
Vol. 13, No. 9 (08.09.2025)
Volume:
13
No.:
9
Date Issued:
08.09.2025
DOI:
10.3390/biomedicines13092200
Language:
English
Type of Resource:
Text
Keywords:
liver transplantation; Crohn’s disease; advanced therapies; biologics; immunosuppression
DDC:
610 Medizin und Gesundheit

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