Long-term outcomes of liver transplantation in patients with gluten enteropathy

Introduction: Liver involvement is one of the most common extraintestinal manifestations in gluten enteropathy. Liver transplantation is considered the gold standard method for end-stage liver patients who do not respond to a gluten-free diet. The aim of our study is to retrospectively investigate the long-term outcomes following liver transplantation in patients with gluten enteropathy. Material and Methods: Twenty-eight patients who underwent liver transplantation between January 2004 and December 2023 at the Gastroenterology Clinic of İnönü University Turgut Özal Medical Center and were diagnosed with gluten enteropathy based on tissue transglutaminase or endomysium antibody positivity and/or biopsy were included. The patients age, gender, transplant types, survi rates, pre- and post-transplant transglutaminase positivity, body mass index, osteoporosis, iron deficiency anemia, as well as post-transplant biliary complications, rejection, and recurrence rates, were investigated. Results: There were a total of 28 patients, 12 males and 16 females, who underwent liver transplantation due to gluten enteropathy. Twenty-six patients received living donor transplants (92.8%), while 2 received cadaveric transplants (7.1%). The 1, 3, 5, and 10-year survival rates of our patients were found to be 92.9%, 92.9%, 84.4%, and 75%, respectively. In our study, biliary complications developed in 71.4% of the patients. None of the patients underwent surgical treatment for biliary complications. All patients with biliary complications were successfully treated with endoscopic and percutaneous methods. Eleven patients (39.3%) experienced rejection. While 22.2% of the patients had normal transglutaminase levels before transplantation, this rate increased to 81.5% after transplantation, and the rate of normalization was significantly increased. There was a significant positive difference in BMI between pre-transplant and post-transplant (p<0.001). Discussion: High survival rates after liver transplantation for gluten enteropathy are quite satisfactory in end-stage liver diseases where there are no other treatment options. Our results suggest that liver transplantation after gluten enteropathy provides significant benefits on weight gain and celiac antibodies. Keywords: Celiac disease, Liver transplantation, Gluten enteropathy