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Background: Limited data are available on the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). We describe the natural history of pre-existing IBD and de novo IBD after SOT., Methods: This was a retrospective, multicenter study that included patients with pre-existing IBD at the time of SOT and patients with de novo IBD after SOT. The primary outcome was IBD progression, defined by escalation of medical treatment, surgical therapy, or hospitalization due to refractory IBD. Risk factors were identified using multivariate Cox proportional hazard analysis., Results: A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) were included. Most patients with pre-existing IBD (92.5%) were in remission before SOT. During follow-up, 32% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 (interquartile range, 1.3-4.6) years. In the de novo cohort, 55% of patients had disease progression with a median time to flare of 1.9 (interquartile range, 0.8-3.9) years after diagnosis. In the pre-existing IBD cohort, active IBD at the time of SOT (hazard ratio, 1.80; 95% confidence interval, 1.14-2.84; P = .012) and the presence of extraintestinal manifestations (hazard ratio, 3.10; 95% confidence interval, 1.47-6.54; P = .003) were predictive factors for IBD progression., Conclusions: One-third of patients with pre-existing IBD and about half of patients with de novo IBD have disease progression after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for IBD progression., (© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Aims: Inflammatory pouch disorders exhibit a heterogeneous clinical spectrum and therapeutic requirements have not been properly studied., Methods: This retrospective, multicentre study included ulcerative colitis patients with ileal pouch construction and were later diagnosed with an inflammatory pouch disorder between 1995 and 2020. Classifications, behaviour and therapies applied were recorded and compared in the long-term., Results: Overall, 338 patients were recruited. The most common disorders were pouchitis (n = 258, 76%), Crohn's disease of the pouch (n = 55, 16%) and cuffitis (n = 25, 7%). Pouchitis presented mainly as chronic (65.2%) and recurrent (87%) forms. Crohn's disease manifested as stricturing/penetrating in 53% of cases and perianal disease in 42%. Patients received multiple therapies: 86% antibiotics, 42% steroids, 27% immunosuppressants, 43% biologics and 27% surgery. Compared with pouchitis, Crohn's disease of the pouch was characterised by a later diagnosis (99 vs. 55 months, p < 0.001) and greater needs for immunosuppressants (OR 3.53, 1.79-6.94, p < 0.0001), biologics (OR 5.45, 2.78-10.6, p < 0.0001) and surgeries (OR 2.65, 1.43-4.89, p < 0.001)., Conclusions: Chronic pouchitis is the most common pouch disorder presentation. These entities have diverse therapeutics requirements, particularly for Crohn's disease of the pouch., Competing Interests: Conflict of interest F. Mesonero has served as a speaker for and received consulting fees from MSD, AbbVie, Takeda, Janssen, Pfizer, Ferring Pharmaceuticals, Kern Pharma, Dr. Falk Pharma, Galapagos, Chiesi Farmaceutici and Faes Farma. - Y. Zabana has received support for conference attendance, speaker fees, research support and consulting fees from AbbVie, Adacyte Therapeutics, Almirall, Amgen, Dr. Falk Pharma, Faes Farma, Ferring Pharmaceuticals, Janssen, MSD, Otsuka, Pfizer, Shire, Takeda, Galapagos, Boehringer Ingelheim and Tillotts Pharma AG. - A. Fernández-Clotet has served as a speaker for and received educational funding from Dr. Falk Pharma, Janssen, Takeda, Chiesi Farmaceutici and Pfizer. - B. Caballol has served as a speaker for and received consulting fees from MSD, AbbVie, Janssen, Takeda, Ferring Pharmaceuticals, Shire Pharmaceuticals and Faes Pharma. - E. Leo-Carnerero has served as a speaker and consultant for and received educational funding from AbbVie, Janssen, Takeda, Ferring Pharmaceuticals, Gilead, Pfizer and Dr. Falk Pharma. - M. J. García has received financial support for travel and educational activities from Janssen, Pfizer, AbbVie, Takeda, Kern Pharma, Faes Farma and Ferring Pharmaceuticals. - R. Ferreiro-Iglesias has received support for conference attendance, speaker fees, research support and consulting fees from AbbVie, Adacyte Therapeutics, Dr. Falk Pharma, Faes Farma, Ferring Pharmaceuticals, Janssen, MSD, Kern, Chiesi Farmaceutici, Gebro Pharma, Pfizer, Shire, Takeda and Tillotts Pharma AG. - M. Calafat has received support for conference attendance, speaker fees, research support and consulting fees from AbbVie, Adacyte Therapeutics, Dr. Falk Pharma, Ferring Pharmaceuticals, Janssen, Pfizer, Takeda, Gilead, Chiesi Farmaceutici and Tillotts Pharma AG. - J. Miranda has received support for conference attendance, speaker fees and consulting and advisory fees from AbbVie, Adacyte Therapeutics, Dr. Falk Pharma, Faes Farma, Ferring Pharmaceuticals, Janssen, Pfizer, Takeda and Tillotts Pharma AG. - L. Torrealba has served as a speaker for and received educational funding from AbbVie, Janssen, Takeda, Ferring Pharmaceuticals, Gilead, Pfizer, Dr. Falk Pharma and Tillotts Pharma AG. - R. Sáiz-Chumillas has served as a speaker for and received consulting fees from Janssen, Ferring Pharmaceuticals and Faes Farma. - A. López has received support for conference attendance, educational funding and speaker fees from Chiesi Farmaceutici, AbbVie, Janssen, Ferring Pharmaceuticals, Takeda, Pfizer and Tillotts Pharma AG. - C. Rubín de Célix has received educational funding from Ferring Pharmaceuticals, Tillotts Pharma AG, AbbVie, Norgine, MSD, Pfizer, Takeda and Janssen and is supported by a grant from the Ministerio de Economía y Competitividad (Instituto de Salud Carlos III, Río Hortega CM21/00025) and co-financed by the European Social Fund Plus (ESF+) ‘Co-financed by the European Union’. - E. Brunet has served as a speaker and consultant for and received educational funding from Janssen, Takeda, Ferring Pharmaceuticals, Kern Pharma, AbbVie and Chiesi Farmaceutici. - A. Hernández has served as a speaker for and received educational funding from AbbVie, Takeda, Kern Pharma, Pfizer, Janssen, Adacyte Therapeutics, Chiesi Farmaceutici, Galapagos and Ferring Pharmaceuticals. - I. González-Partida has received support for conference attendance and speaker fees from AbbVie, Dr. Falk Pharma, Ferring Pharmaceuticals, Janssen, MSD, Kern, Pfizer, Shire, Takeda and Tillotts Pharma AG. - I. Rodríguez-Lago has received financial support for travel and educational activities from or has served as an advisory board member for AbbVie, Adacyte Therapeutics, Celltrion, Chiesi Farmaceutici, Danone, Ferring Pharmaceuticals, Faes Farma, Janssen, Galapagos, MSD, Otsuka Pharmaceutical, Pfizer, Roche, Takeda and Tillotts Pharma. I. R.-L. has also received financial support for research from Tillotts Pharma AG and is supported by research grants from Gobierno Vasco – Eusko Jaurlaritza (grant no. 2020111061) and Biobizkaia HRI (grant no. BCB/I/LIB/22/008). - M. C. Rodríguez-Grau has served as a speaker for Takeda, Shire Pharmaceutics and Dr. Falk Pharma and has received education funding from Pfizer, Takeda, Janssen, MSD, Dr. Falk Pharma, Shire Pharmaceutics, Mylan, Norgine, Chiesi Farmaceutici, Faes Farma, Ferring Pharmaceuticals and AbbVie. - A. Elosua has served as a speaker for or has received educational funding from AbbVie, Adacyte Therapeutics, Takeda, Faes Farma, Ferring Pharmaceuticals, Janssen and Tillotts Pharma AG. - J. Huguet has received fees for educational activities, research projects, scientific meetings and advisory boards sponsored by MSD, Ferring Pharmaceuticals, AbbVie, Janssen, Biogen, Sandoz, Kern Pharma, Faes Farma and Takeda. - M. Barreiro de Acosta has served as a speaker, consultant and advisory member for and has received research funding from MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Gilead, Galapagos, BMS, Celgene, Pfizer, Sandoz, Biogen, Fresenius, Ferring Pharmaceuticals, Faes Farma, Dr. Falk Pharma, Chiesi Farmaceutici, Gebro Pharma, Adacyte Therapeutics and Vifor Pharma. Remaining authors declare that they have no known competing financial interest or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders., Objective: To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders., Design: This was a retrospective and multicentre study., Methods: We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI)., Results: In all, 63 patients were included [54% males; median age, 49 (28-77) years]. The therapy was used to treat pouchitis ( n  = 37) or Crohn's disease of the pouch ( n  = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11-55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2-4) to 1 (range 0-3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy., Conclusion: Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option., Competing Interests: Francisco Mesonero has served as a speaker for and received consulting fees from MSD, AbbVie, Takeda, Janssen, Pfizer, Ferring, Kern-Pharma, Dr. Falk Pharma, Galapagos, Chiesi and Faes Farma. Yamile Zabana has received support for conference attendance, speaker fees, research support and consulting fees from AbbVie, Adacyte, Almirall, Amgen, Dr. Falk Pharma, FAES Pharma, Ferring, Janssen, MSD, Otsuka, Pfizer, Shire, Takeda, Galapagos, Boehringer Ingelheim and Tillots. Agnés Fernández-Clotet has served as a speaker for and received educational funding from Dr. Falk Pharma, Janssen, Takeda, Chiesi and Pfizer. Eduardo Leo-Carnerero has served as a speaker and consultant for and received educational funding from AbbVie, Janssen, Takeda, Ferring, Gilead, Pfizer and Dr. Falk Pharma. Andrea Núñez-Ortiz has received educational funding from Janssen, Takeda, Ferring and Pfizer. Berta Caballol has served as a speaker for and received consulting fees from MSD, AbbVie, Janssen, Takeda, Ferring, Shire Pharmaceuticals and Faes Pharma. Rocío Ferreiro-Iglesias has received support for conference attendance, speaker fees, research support and consulting fees from AbbVie, Adacyte, Dr. Falk Pharma, FAES Pharma, Ferring, Janssen, MSD, Kern, Chiesi, Gebro Pharma, Pfizer, Shire, Takeda and Tillots. José Miranda-Bautista has received support for conference attendance, speaker fees, and consulting and advisory fees from AbbVie, Adacyte, Dr. Falk Pharma, FAES Pharma, Ferring, Janssen, Pfizer, Takeda and Tillots. Leyanira Torrealba has served as a speaker for and received educational funding from AbbVie, Janssen, Takeda, Ferring, Gilead, Pfizer, Dr. Falk Pharma and Tillotts Pharma. Rosa María Sáiz-Chumillas has served as a speaker for and received consulting fees from Janssen, Ferring and Faes Farma. Alicia López-García has received support for conference attendance, educational funding and speaker fees from Chiesi, AbbVie, Janssen, Ferring, Takeda, Pfizer and Tillots. Cristina Rubín de Célix has received educational funding from Ferring, Tillotts Pharma, AbbVie, Norgine, MSD, Pfizer, Takeda and Janssen and is supported by a grant from the Ministerio de Economía y Competitividad (Instituto de Salud Carlos III, Rio Hortega CM21/00025) and co-financed by the European Social Fund Plus (ESF+) ‘Co-financed by the European Union’. Eduard Brunet has served as a speaker and consultant for and received educational funding from Janssen, Takeda, Ferring, Kern-Pharma, AbbVie and Chiesi. Alejandro Hernández-Camba has served as a speaker for and received educational funding from AbbVie, Takeda, Kern Pharma, Pfizer, Janssen, Adacyte Therapeutics, Chiesi, Galapagus and Ferring. Iago Rodríguez-Lago has received financial support for travelling and educational activities from or has served as an advisory board member for AbbVie, Adacyte, Celltrion, Chiesi, Danone, Dr. Falk Pharma, Ferring, Faes Farma, Janssen, Galapagos, MSD, Otsuka Pharmaceutical, Pfizer, Roche, Takeda and Tillotts Pharma. Iago Rodríguez-Lago has also received financial support for research from Tillotts Pharma and is supported by a research grant from Gobierno Vasco – Eusko Jaurlaritza [Grant No. 2020222004]. Alfonso Elosua has served as a speaker for and has received educational funding from AbbVie, Adacyte, Takeda, FAES Farma, Ferring, Janssen and Tillots Pharma. José María Huguet has received fees for educational activities, research projects, scientific meetings and advisory boards sponsored by MSD, Ferring, AbbVie, Janssen, Biogen, Sandoz, Kern Pharma, Faes Farma and Takeda. Manuel Barreiro-de Acosta has served as a speaker, consultant and advisory member for and has received research funding from MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Gilead, Celgene, Pfizer, Sandoz, Biogen, Fresenius, Ferring, Faes Farma, Dr. Falk Pharma, Chiesi, Gebro Pharma, Adacyte and Vifor Pharma., (© The Author(s), 2024.)