Safety of anti-TNF treatment in liver transplant recipients: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND AND AIM: Little is known about the risk of serious infection when combining anti-tumour necrosis factor [TNF] therapy for refractory inflammatory bowel disease [IBD] with immunosuppression after liver transplantation [LT]. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data. METHODS: A search was conducted for full papers and conference proceedings through September 2015, regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale [NOS]. Two reviewers independently extracted patient data [age, duration of follow-up, number of all infections, number of serious infections, time since transplant]. As an additional control population, primary sclerosing cholangitis [PSC]-IBD patients from the Leiden University Medical Center [LUMC] LT cohort were used. Poisson regression was used to compare serious infections (according to International Conference on Harmonisation [ICH] definition) per patien-year follow-up between the anti-TNF and control groups. RESULTS: In all 465 articles and abstracts were identified, of which eight were included. These contained 53 post-LT patients on anti-TNF therapy and 23 post-LT patients not exposed to anti-TNF therapy. From the LUMC LT-cohort, 41 PSC patients with PSC-IBD not exposed to anti-TNF therapy were included as control population. The infection rate for TNF-exposed patients was 0.168 serious infections per patient year, compared with 0.149 in the control patients (rate ratio 1.12 [95% confidence interval: 0.233-5.404, P = 0.886]. When correcting for time since transplant, the infection rate was 0.194 in the TNF-exposed vs 0.115 in the non-exposed [p = 0.219]. CONCLUSIONS: No significant increase in the rate of serious infection was observed in LT recipients with PSC-IBD during exposure to anti-TNF therapy.
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In the post-transplant setting, anti-TNF has proven effective for IBD and is safe.
“In the post-transplant setting, anti-TNF has proven effective for IBD and is safe.375,376”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [376]
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- Authors
- Westerouen van Meeteren, M. J., Hayee, B., Inderson, A., van der Meulen, A. E., Altwegg, R., van Hoek, B., Pageaux, G. P., Stijnen, T., Stein, D., & Maljaars, P. W. J.
- Affiliations
- King's College Hospital (GB)
- Leiden University Medical Center (NL)
- Hôpital Saint Eloi (FR)
- Medical College of Wisconsin (US)
- Venue
- Journal of Crohn's and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-06
- Volume
- 11
- Issue
- 9
- Pages
- 1146-1151
- ISSN
- 1873-9946 (ISSN-L)
- 1876-4479
- OpenAlex
- W2611235300
- Cited by
- 39
- References
- 22
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 1
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Crohn s and Colitis (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Keywords
- anti-TNF therapy, liver transplantation
- MeSH terms
- Gastrointestinal Agents, Graft Rejection, Humans, Immunosuppressive Agents, Infections, Postoperative Complications, Regression Analysis, Risk Factors, Tumor Necrosis Factor-alpha, Cholangitis, Sclerosing, Inflammatory Bowel Diseases, Models, Statistical, Liver Transplantation
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