P825 The course of inflammatory bowel disease in setting of liver transplantation

Abstract Background Liver transplantation (LT) remains the only therapeutic option for patients with primary sclerosing cholangitis (PSC) who develop biliary tract complications or cirrhosis. Around 50-80% of PSC have IBD which represent phenotypically unique disease. Patients are prone to negative effects liver disease and immunosuppression, unpredictable course both diseases development neoplasia. treated according standard guidelines related overall population. Methods The study evaluates therapy in transplanted patients. In a period 2005-October 2022 1453 had LT performed at University hospital Merkur, Zagreb, Croatia. 70 (4.8%) them refers PSC. 46 (66%) were diagnosed IBD, majority 43 (93.5%) before LT. Results As expected 36 (78.3%) ulcerative colitis (UC) while 9 (19.6%) Crohns 31 (70%) males, median age 35 years (IQR 28-47). (76.1%) no activity LT, whereas 11 (23.9%) continuously active follow up. 18 (51.4%) remission developed relapse (median time 536 days, IQR 371-1234) other 17 (48.6%) stable remission. Nine malignant disease, 3 (6,5%) cholangiocelular carcinoma explanted liver, 5 (10,9%) colorectal cancer (CRC) 1 tumors. Before 24 (52.2%) specific treatment, 8 (33.3%) aminosalicilates (AsA), (10.9%) azathioprine (AzA), 6 (13.1%) glucocorticoids (GK) (6.5%) biologics. After 23 (50%) ASA, 12 (26.1%) AzA biological (36.4% anti-TNF, 27,3% vedolizumab 36,4% on multiple biologics). AsA as monotherapy is successful 63.6% patients, 50% biologic 27.3%, respectfully. Even though it did not reach statistical significance, more after than group (33.3 vrs 9.1%) this opposite (27.8 54.5%). (17.4%) total colectomy, 2 before, during due CRC intractable IBD. Regrading immunosuppression 42 (91.3%) tacrolimus, 4 (8.7%) cyclosporine, mycophenolate mofetil prolonged GK. Conclusion Management context setting major clinical challenge urgently needed. Since effectiveness possibly weaker high risk necessary consider an earlier approach colectomy.