Abstract Background Patients with inflammatory bowel disease (IBD) may require liver transplantation due to advanced liver diseases such as primary sclerosing cholangitis. However, evidence regarding the course of disease, including IBD activity and the use of advanced therapies among patients with liver transplantation, remain limited. Therefore, this study aimed to assess IBD activity before and after transplantation and to evaluate the utilization of advanced IBD treatments. Methods This multicenter retrospective cohort study included 253 patients with IBD who underwent liver transplantation between 2000 and 2022 across four German university hospitals. Clinical and endoscopic disease activity, as well as the use of advanced therapies, were assessed before and after transplantation. Results The cohort included 213 patients with ulcerative colitis (UC) and 40 with Crohn’s disease (CD). Clinical remission prior to liver transplantation was achieved in 84.7% of ulcerative colitis patients and 89.7% of those with Crohn’s disease, with no significant change after transplantation (UC: 81.2%, CD: 85.7%; p = 0.554 and p = 0.650). Despite stable clinical remission rates following transplantation, a considerable proportion of patients showed moderate to severe endoscopic disease activity during long-term follow-up (27.9% in UC and 22.6% in CD). Although all patients received liver transplant–specific immunosuppression, the use of IBD-specific advanced therapies increased after transplantation (from 5.9% to 12.6%, p = 0.022), without a corresponding rise in infectious complications (p = 0.102). Conclusion Although clinical disease activity remained stable after liver transplantation, moderate to severe mucosal inflammation persisted in a considerable subset of patients during long-term follow-up. The increasing post-transplant use of advanced therapies, without a corresponding rise in infectious risk, emphasizes the importance of individualized and sustained IBD management in liver transplant recipients. Conflict of interest: Dr. Ar, Ebru: No conflict of interest Solomonidou, Irini: No conflict of interest Lenzen, Henrike: No conflict of interest Wiestler, Miriam: Financial compensation for lectures, advisory boards, other medical-scientific services by: AbbVie, Alfasigma, CED Service, Dr. Falk Pharma, FomF Forum für medizinische Fortbildung, FORUM Institut für Management GmbH, Johnson & Johnson, Lilly Deutschland GmbH, Pfizer, Takeda Pharma. Veltkamp, Claudia: No conflict of interest Willuweit, Katharina: No conflict of interest Rashidi-Alavijeh, Jassin: No conflict of interest Schmidt, Hartmut H.: No conflict of interest Vollenberg, Richard: No conflict of interest Tepasse, Phil-Robin: No conflict of interest Bulut, Dilan: No conflict of interest Trebicka, Jonel: No conflict of interest Tischendorf, Stefanie: No conflict of interest Elfers, Carsten: No conflict of interest Hamesch, Karim: No conflict of interest Bokemeyer, Arne: No conflict of interest
Ar et al. (Thu,) studied this question.