Observational studyDigestive diseases and sciences2026
Safety and Efficacy of Upadacitinib in Patients with Inflammatory Bowel Disease After Liver Transplantation: A Case Series.
Observational study in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeApproximately 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.
methodsRetrospective, single-center observational study at a tertiary center, identifying patients after LT who received UPA. We assessed efficacy and safety of UPA.
resultsFour 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.
conclusionIn 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.
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