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. 2025 Nov 20.
doi: 10.1007/s10620-025-09569-9. Online ahead of print.

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

Yusuke Miyatani  1 , David Choi  1 , Andrew I Aronsohn  2 , Anjana Pillai  2 , Russell D Cohen  1 , David T Rubin  3
Affiliations

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

Yusuke Miyatani et al. Dig Dis Sci. .

Abstract

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.

Keywords: Inflammatory bowel disease; Janus kinase inhibitors; Post-liver transplant; Upadacitinib.

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Conflict of interest statement

Declarations. Conflict of interest: YM has received consultant fee from Takeda. D. Choi has served on the speaker bureau for Janssen Pharmaceuticals, Abbvie, Eli Lilly; and has served as a consultant to Bristol Myers Squibb, and Boehringer Ingelheim, Abbvie, Eli Lilly, Janssen Pharmaceuticals, Pfizer. AIA has nothing to disclose. AP has nothing to disclose RDC serves on the speakers bureau for Abbvie and has served as a consultant for Abbvie, Bausch Health, BMS, Eli Lilly, Genentech, Gilead Sciences, Johnson & Johnson, Pfizer, and Takeda. DTR has received grant support from Takeda; and has served as a consultant for Abbvie, Abivax SA, Altrubio, Athos Therapeutics, Inc, Bristol-Myers Squibb, Celltrion, Connect BioPharma, Eli Lilly & Co., Genentech (Roche) Inc., Iterative Health, Janssen Pharmaceuticals, Johnson & Johnson, Merck & Co., Mirador, Odyssey Therapeutics, Pfizer, Sanofi, Spyre, Takeda Pharmaceuticals, Vedanta Biosciences, and Ventyx. Board of Directors: Cornerstones Health (non-profit), iUSCAN (non-profit). Ethical approval: This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards, with approval from the Institutional Review Board at the University of Chicago.

References

    1. Gordon H, Burisch J, Ellul P et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2024;18:1–37. https://doi.org/10.1093/ecco-jcc/jjad108 . - DOI - PubMed
    1. Bowlus CL, Arrivé L, Bergquist A et al. AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma. Hepatology. 2023;77:659–702. https://doi.org/10.1002/hep.32771 . - DOI - PubMed
    1. Barberio B, Massimi D, Cazzagon N, Zingone F, Ford AC, Savarino EV. Prevalence of Primary Sclerosing Cholangitis in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Gastroenterology. 2021;161:1865–1877. https://doi.org/10.1053/j.gastro.2021.08.032 . - DOI - PubMed
    1. EASL Clinical Practice Guidelines on sclerosing cholangitis. J Hepatol. 2022;77:761–806. https://doi.org/10.1016/j.jhep.2022.05.011 . - DOI
    1. Hov JR, Karlsen TH. The microbiota and the gut-liver axis in primary sclerosing cholangitis. Nat Rev Gastroenterol Hepatol. 2023;20:135–154. https://doi.org/10.1038/s41575-022-00690-y . - DOI - PubMed

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